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Cheng J, Chen L, Tao X, Qiang X, Li R, Ma J, Shi D, Qiu Z. Efficacy of surgical methods for peri-implantitis: a systematic review and network meta-analysis. BMC Oral Health 2023; 23:227. [PMID: 37076816 PMCID: PMC10116816 DOI: 10.1186/s12903-023-02956-6] [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: 10/21/2022] [Accepted: 04/10/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Peri-implantitis is the most difficult biological complication associated with dental implants, often requiring surgical treatments in advanced stages. This study compares the effectiveness of different surgical methods for peri-implantitis. METHODS Randomized controlled trials (RCTs) of different surgical treatments for peri-implantitis were extracted from EMBASE, Web of Science, Cochrane Library databases, and PubMed systematically. Pairwise comparisons and network meta-analyses (NMA) were conducted to analyze the effect of surgical treatments on probing depth (PD), radiographic bone fill (RBF), mucosal recession (MR), bleeding on probing (BOP), and clinical attachment level (CAL). In addition, risk of bias, quality of evidence, and statistical heterogeneity of the selected studies were evaluated. A total of 13 articles were included in this study, involving open flap debridement (OFD), resective therapy (RT), and augmentative therapy (AT) with and without adjunctive treatments (laser therapy, photodynamic therapy, local antibiotics, phosphoric acid, and ozone therapy). RESULTS AT improved RBF and CAL more than OFD, but does not outperform OFD in reducing peri-implant soft-tissue inflammation. AT, OFD and RT did not significantly alter the levels of MR. Addition of ozone therapy improved the effect of AT, but addition of photodynamic therapy did not affect PD reduction and CAL gain significantly. Similarly, adjuvant treatment with phosphoric acid during RT did not significantly change the outcome of BOP. CONCLUSIONS Within the limitation of this systematic review and NMA, AT was superior to OFD in improving peri-implantitis outcomes. While adjunct use of ozone therapy may further improve the efficacy of AT, the limited evidence supporting this combination therapy argues for cautionary interpretation of these results.
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Affiliation(s)
- Jing Cheng
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Liang Chen
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, People's Republic of China
| | - Xian Tao
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Xiang Qiang
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Ruiying Li
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Jia Ma
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China
| | - Dong Shi
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, People's Republic of China.
| | - Zijin Qiu
- Stomatological Hospital of Xiamen Medical College, Xiamen Medical College, Xiamen, People's Republic of China.
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, People's Republic of China.
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In-Vitro Biofilm Removal Efficacy Using Water Jet in Combination with Cold Plasma Technology on Dental Titanium Implants. Int J Mol Sci 2023; 24:ijms24021606. [PMID: 36675120 PMCID: PMC9867126 DOI: 10.3390/ijms24021606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Peri-implantitis-associated inflammation can lead to bone loss and implant failure. Current decontamination measures are ineffective due to the implants' complex geometry and rough surfaces providing niches for microbial biofilms. A modified water jet system (WaterJet) was combined with cold plasma technology (CAP) to achieve superior antimicrobial efficacy compared to cotton gauze treatment. Seven-day-old multi-species-contaminated titanium discs and implants were investigated as model systems. The efficacy of decontamination on implants was determined by rolling the implants over agar and determining colony-forming units supported by scanning electron microscopy image quantification of implant surface features. The inflammatory consequences of mono and combination treatments were investigated with peripheral blood mononuclear cell surface marker expression and chemokine and cytokine release profiles on titanium discs. In addition, titanium discs were assayed using fluorescence microscopy. Cotton gauze was inferior to WaterJet treatment according to all types of analysis. In combination with the antimicrobial effect of CAP, decontamination was improved accordingly. Mono and CAP-combined treatment on titanium surfaces alone did not unleash inflammation. Simultaneously, chemokine and cytokine release was dramatically reduced in samples that had benefited from additional antimicrobial effects through CAP. The combined treatment with WaterJet and CAP potently removed biofilm and disinfected rough titanium implant surfaces. At the same time, non-favorable rendering of the surface structure or its pro-inflammatory potential through CAP was not observed.
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Effectiveness of Different Chemotherapeutic Agents for Decontamination of Infected Dental Implant Surface: A Systematic Review. Antibiotics (Basel) 2022; 11:antibiotics11050593. [PMID: 35625237 PMCID: PMC9137954 DOI: 10.3390/antibiotics11050593] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 01/27/2023] Open
Abstract
Aim: To evaluate the most effective chemotherapeutic agent for decontamination of infected dental implants. Material and methods: A systematic electronic literature search in MEDLINE (PubMed) and Google scholar between January 2010 to December 2021 was carried out by using the PRISMA guidelines. A total of five studies related to chemical decontamination of the dental implant were evaluated. The search strategy was based on the PICOS framework. Randomized controlled trials (RCT’s) and cohort studies evaluating the effectiveness of different chemotherapeutic agents for the decontamination of dental implants were included in the study. The outcome variable examined was the most effective chemotherapeutic agent(s) for dental implant surface decontamination after comparing the chemotherapeutic agents used in the qualifying studies. Result: Out of the basic database of 1564 records, 1380 articles were excluded due to irrelevance, unavailability, and repetition. Furthermore, 134 articles were excluded from 184 studies for various reasons. After further filtration, 13 studies were shortlisted. Two investigators (SSA and SA) appraised the quality of the selected studies using the risk of bias assessment tool. After excluding eight studies, five articles were finally included in the present systematic review. Conclusion: The data reported for the efficacy of chemotherapeutic agents in cleaning contaminated titanium surfaces are scarce, thus it is not possible to draw a definite conclusion. However, chlorhexidine (CHX) (0.2%, 0.12%), citric acid (40%) and sodium hypochlorite (1%) are the most commonly used chemotherapeutic agents; amongst them, citric acid showed the highest potential for biofilm removal from the contaminated implant surface. All three agents [CHX (0.2%, 0.12%), citric acid (40%), and sodium hypochlorite (1%)] can be recommended as therapeutic agents along with their curbs.
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Schwarz F, Jepsen S, Obreja K, Galarraga-Vinueza ME, Ramanauskaite A. Surgical therapy of peri-implantitis. Periodontol 2000 2022; 88:145-181. [PMID: 35103328 DOI: 10.1111/prd.12417] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Peri-implantitis is caused by a bacterial challenge; therefore, anti-infective treatment strategies should be employed to manage the disease. As nonsurgical approaches demonstrate limited efficacy in most cases of peri-implantitis, surgical interventions are often required. Treatment outcomes improve following access flap surgery, with or without adjunctive resective and/or augmentation measures. Whereas nonaugmentative therapies (ie, access flap surgery and resective techniques) primarily aim to resolve inflammation and arrest further disease progression, augmentation approaches also seek to regenerate the bony defect and achieve reosseointegration. Currently, limited evidence supports the superiority of augmentative surgical techniques for peri-implantitis treatment over nonaugmentation methods, and human histologic evidence for reosseointegration is sparse. For patients involved in regular postoperative maintenance programs, success of peri-implantitis surgical treatment based on various definitions of success was obtained in over half of the cases after 5-7 years. Despite surgical treatment, cases of further disease progression that required retreatment or led to implant loss were reported.
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Affiliation(s)
- Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
| | - Maria Elisa Galarraga-Vinueza
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt an Main, Germany
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Verardi S, Valente NA. Peri-Implantitis: Application of a Protocol for the Regeneration of Deep Osseous Defects. A Retrospective Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312658. [PMID: 34886384 PMCID: PMC8656633 DOI: 10.3390/ijerph182312658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
Background and aims: Peri-implantitis is a complex pathology, both in its diagnosis and in the identification of etiological causes. Although we have been studying more and more over the years to try to answer the many questions that remain regarding everything that circulates around this disease which affects implants, nothing has yet been taken as an official consensus regarding its surgical treatment. There are still many proposed protocols, each of which has been shown to have comforting results and promising prospects, but no total predictability. The aim of this case series is to assess the clinical outcomes of a mixed protocol for the regeneration of deep osseous defects. Materials and methods: The data and clinical records of 23 patients, with 29 implants affected by peri-implantitis treated surgically in private practice, were analyzed retrospectively. The method used for the surgical treatment was a mixed protocol of mechanical–chemical decontamination and bone regeneration with bovine xenograft. Results: All patients were followed for at least 2 years, averaging 28.9 months (a range of 24–38 months) with a reduction in the probing depth (PD) at one year from the initial 8.14 ± 1.156 mm to 3.72 ± 0.649 mm, and to 4.14 ± 1.093 mm at the final assessment. The differences between assessment time points were always statistically significant. The data regarding bleeding on probing (BoP) and suppuration also showed a statistically significant reduction at the final time point compared to the baseline. Only one patient, at 24 months, still showed BoP, suppuration, and a PD deeper than 5 mm, indicating a recurrence of the disease compared to the initial improvement of the PD (5 mm) at one year. Conclusions: In conclusion, within the limits of this retrospective analysis, it can be affirmed that this combined mechanical–chemical and regenerative decontamination therapy is effective in the treatment of peri-implantitis.
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Affiliation(s)
- Simone Verardi
- Department of Periodontics, University of Washington, Seattle, WA 98195, USA;
| | - Nicola Alberto Valente
- Department of Periodontology, School of Dental Medicine, University of Cagliari, 09124 Cagliari, Italy
- Department of Periodontics and Endodontics, State University of New York at Buffalo, New York, NY 14214, USA
- Correspondence:
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Hentenaar DFM, De Waal YCM, Stewart RE, Van Winkelhoff AJ, Meijer HJA, Raghoebar GM. Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial. Clin Oral Implants Res 2021; 33:184-196. [PMID: 34808006 PMCID: PMC9299917 DOI: 10.1111/clr.13881] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 01/14/2023]
Abstract
Objectives To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri‐implantitis. Material and Methods During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline‐soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow‐up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full‐mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann–Whitney U test. Results No differences between the test and control group were found for BoP over 12 months of follow‐up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1‐year follow‐up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%). Conclusions Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri‐implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success. Trial registry: https://www.trialregister.nl/ Identifier: NL8621.
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Affiliation(s)
- Diederik F M Hentenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne C M De Waal
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie Jan Van Winkelhoff
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lopez MA, Passarelli PC, Godino E, Lombardo N, Altamura FR, Speranza A, Lopez A, Papi P, Pompa G, D’Addona A. The Treatment of Peri-Implant Diseases: A New Approach Using HYBENX ® as a Decontaminant for Implant Surface and Oral Tissues. Antibiotics (Basel) 2021; 10:antibiotics10050512. [PMID: 33946370 PMCID: PMC8147150 DOI: 10.3390/antibiotics10050512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Peri-implantitis is a pathological condition characterized by an inflammatory process involving soft and hard tissues surrounding dental implants. The management of peri-implant disease has several protocols, among which is the chemical method HYBENX®. The aim of this study is to demonstrate the efficacy of HYBENX® in the treatment of peri-implantitis and to compare HYBENX® with other chemical agents used in the surgical treatment of peri-implantitis. Methods: The present study included a population of ten subjects with severe peri-implantitis. The procedure used in the study involves the application of HYBENX® after open-flap debridement. Each patient has been followed for 12 months after a single application of the decontaminant agent. Clinical and radiographical parameters were recorded at baseline, 3 months, and 12 months after treatment completion. Results: At baseline, a mean pocket probing depth (PPD) of 7.3 ± 0.5 mm and a mean clinical attachment level (CAL) of 8.8 ± 0.8 mm was recorded. An average residual PPD of 4.2 ± 0.5 mm and a mean CAL of 5.2 ± 0.8 mm were observed after 1 year. Additionally, the average of bone gain was about 3.4 mm, with a mean marginal bone level (MBL) change from 5.8 mm (baseline) to 2.4 mm (12 months). In total, 90% of the treated implants reached the success rate after the 1-year follow-up. Only in one case out of ten treated implants was resolution of the disease not achieved. Conclusion: Clinical improvements highlight that the procedure of open-flap debridement (OFD) + HYBENX® may be considered an effective technique in the treatment of peri-implantitis. From the results obtained, it can be concluded that the use of HYBENX® in the surgical treatment of peri-implantitis is promising. Overall, this protocol demands further studies to better understand the role and potential benefits of HYBENX® in the treatment of peri-implantitis.
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Affiliation(s)
| | - Pier Carmine Passarelli
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Emmanuele Godino
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Nicolò Lombardo
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Francesca Romana Altamura
- Department of Oral and Maxillo Facial Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.R.A.); (G.P.)
| | - Alessandro Speranza
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
| | - Andrea Lopez
- Universidad Europea de Madrid, 28670 Madrid, Spain;
| | - Piero Papi
- Department of Oral and Maxillo Facial Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.R.A.); (G.P.)
- Correspondence:
| | - Giorgio Pompa
- Department of Oral and Maxillo Facial Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (F.R.A.); (G.P.)
| | - Antonio D’Addona
- Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Department of Head and Neck, Catholic University of the Sacred Heart, Gemelli University Polyclinic Foundation, 00168 Rome, Italy; (P.C.P.); (E.G.); (N.L.); (A.S.); (A.D.)
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Bertl K, Stavropoulos A. A Mini Review on Non-augmentative Surgical Therapy of Peri-Implantitis—What Is Known and What Are the Future Challenges? FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.659361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Non-augmentative surgical therapy of peri-implantitis is indicated for cases with primarily horizontal bone loss or wide defects with limited potential for bone regeneration and/or re-osseointegration. This treatment approach includes a variety of different techniques (e.g., open flap debridement, resection of peri-implant mucosa, apically positioned flaps, bone re-contouring, implantoplasty, etc.) and various relevant aspects should be considered during treatment planning. The present mini review provides an overview on what is known for the following components of non-augmentative surgical treatment of peri-implantitis and on potential future research challenges: (1) decontamination of the implant surface, (2) need of implantoplasty, (3) prescription of antibiotics, and (4) extent of resective measures.
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Balderrama ÍDF, Stuani VDT, Cardoso MV, Oliveira RC, Lopes MMR, Greghi SLA, Adriana Campos Passanezi S. The influence of implant surface roughness on decontamination by antimicrobial photodynamic therapy and chemical agents: A preliminary study in vitro. Photodiagnosis Photodyn Ther 2020; 33:102105. [PMID: 33217567 DOI: 10.1016/j.pdpdt.2020.102105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/06/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this preliminary study was to analyze the effectiveness of three different protocols of decontamination on five commercial moderate rough implants. MATERIAL AND METHODS The types of implants investigated were: Neoporos Drive CM (CM; Neodent®), Drive CM Acqua (ACQ; Neodent®), SLActive (SLA; Straumann®), Osseotite (OT; Biomet 3i®) and Nanotite (NT; Biomet 3i®). Implant surface properties (n = 2/type of implant; control groups) were analyzed by scanning electron microscopy (SEM) images to determine surface roughness parameters (SRP) and energy disperse X-ray spectrometry to determine the chemical composition. Implants were then inoculated with Aggregatibacter actinomycetencomitans in vitro (n = 6/type of implant;experimental groups) and the contaminated areas were determined in SEM images (500x magnifications). Decontamination of implants was performed in duplicate by three protocols: antimicrobial photodynamic therapy (aPDT), EDTA associated with citric acid (EDTA + CA) and 0.12 % chlorhexidine (CHX). The remaining contaminated area (rCtA) was determined in SEM images (500x magnifications). All quantitative analysis through SEM images were analyzed in ImageJ® software for two-dimensional parameters. RESULTS No significant differences were found in SRP among implants (control group), except for Rv (lowest valley) between SLA vs. OT (p=0.0031; Kruskal Wallis post hoc Dunn). NT implants showed highest contaminated area vs. ACQ implants (68.19 % ± 8.63 % and 57.32 % ± 5.38 %, respectively; p = 0.0016, Tukey's test). SRP after decontamination showed statistical difference for Ra (arithmetical mean deviation) for all decontamination groups when compared to control (p < 0.05; ANOVA with post-hoc Tukey's multiple comparisons test), only CM implants showed statistical difference when compared decontamination protocols to control with highest modification of SRP for EDTA + AC group. For decontamination analysis, for applicability of different protocols in the same type of implant, only SLA showed statistical significant difference for aPDT vs. EDTA + CA (p = 0.0114; ANOVA with post-hoc Tukey's multiple comparisons test) with lowest rCTA for aPDT, however for ACQ implants the aPDT showed lowest rCTA with no statistical difference (p > 0.05; ANOVA with post-hoc Tukey's multiple comparisons test). No statistical difference was observed between the decontamination protocols at other implant types. CONCLUSION It can be suggested that the chemical-physical characteristics of dental implants can be effected by the process of contamination and decontamination by aPDT and chemical agents.
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Affiliation(s)
- Ísis de Fátima Balderrama
- Department of Diagnosis and Surgery, Araraquara School of Dentistry, Sao Paulo State University, Araraquara, SP, Brazil; Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.
| | - Vitor de Toledo Stuani
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.
| | - Matheus Völz Cardoso
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.
| | - Rodrigo Cardoso Oliveira
- Department of Biological Science, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.
| | | | - Sebastião Luiz Aguiar Greghi
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.
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Koch M, Burkovski A, Zulla M, Rosiwal S, Geißdörfer W, Dittmar R, Grobecker-Karl T. Pilot Study on the Use of a Laser-Structured Double Diamond Electrode (DDE) for Biofilm Removal from Dental Implant Surfaces. J Clin Med 2020; 9:jcm9093036. [PMID: 32967183 PMCID: PMC7565428 DOI: 10.3390/jcm9093036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/04/2023] Open
Abstract
No proper treatment option for peri-implantitis exists yet. Based on previous studies showing the in vitro effectiveness of electrochemical disinfection using boron-doped diamond electrodes, novel double diamond electrodes (DDE) were tested here. Using a ceramic carrier and a laser structuring process, a clinically applicable electrode array was manufactured. Roughened metal discs (n = 24) made from Ti-Zr alloy were exposed to the oral cavities of six volunteers for 24 h in order to generate biofilm. Then, biofilm removal was carried out either using plastic curettes and chlorhexidine digluconate or electrochemical disinfection. In addition, dental implants were contaminated with ex vivo multispecies biofilm and disinfected using DDE treatment. Bacterial growth and the formation of biofilm polymer were determined as outcome measures. Chemo-mechanical treatment could not eliminate bacteria from roughened surfaces, while in most cases, a massive reduction of bacteria and biofilm polymer was observed following DDE treatment. Electrochemical disinfection was charge- and time-dependent and could also not reach complete disinfection in all instances. Implant threads had no negative effect on DDE treatment. Bacteria exhibit varying resistance to electrochemical disinfection with Bacillus subtilis, Neisseria sp., Rothiamucilaginosa, Staphylococcus haemolyticus, and Streptococcus mitis surviving 5 min of DDE application at 6 V. Electrochemical disinfection is promising but requires further optimization with respect to charge quantity and application time in order to achieve disinfection without harming host tissue.
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Affiliation(s)
- Maximilian Koch
- Microbiology Division, Department of Biology, University of Erlangen-Nuremberg, 91058 Erlangen, Germany;
| | - Andreas Burkovski
- Microbiology Division, Department of Biology, University of Erlangen-Nuremberg, 91058 Erlangen, Germany;
- Correspondence: ; Tel.: +49-91318528086
| | - Manuel Zulla
- Division of Ultra-Hard Coatings, Department of Material Sciences, University of Erlangen-Nuremberg, 91058 Erlangen, Germany;
| | - Stefan Rosiwal
- Chair of Materials Science and Engineering for Metals, Department of Material Sciences, University of Erlangen-Nuremberg, 91058 Erlangen, Germany;
| | - Walter Geißdörfer
- Institute of Clinical Microbiology, Immunology and Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
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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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Bianchini MA, Galarraga-Vinueza ME, Apaza-Bedoya K, De Souza JM, Magini R, Schwarz F. Two to six-year disease resolution and marginal bone stability rates of a modified resective-implantoplasty therapy in 32 peri-implantitis cases. Clin Implant Dent Relat Res 2019; 21:758-765. [PMID: 30985073 DOI: 10.1111/cid.12773] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Different nonsurgical, antibacterial, surgical, and regenerative approaches to treat peri-implantitis have been proposed, but there is no an actual "gold" standard treatment showing the most favorable results to counteract peri-implantitis effects. PURPOSE To evaluate radiographically and clinically the disease resolution and peri-implant marginal bone stability rates of peri-implantitis cases treated through a combined resective-implantoplasty therapy in a moderate to long-term period. MATERIALS AND METHODS Records of patients diagnosed with peri-implantitis and treated through the same protocol applying a combined resective-implantoplasty therapy with minimum 2-year follow-up were screened. Eligible patients were contacted and asked to undergo clinical and radiologic examination. Progressive marginal bone loss, bleeding on probing, suppuration, implant mobility, and implant fracture were considered to establish the disease resolution rate and peri-implant bone stability of the treated implants. RESULTS Twenty-three patients with 32 treated implants fulfilled the inclusion criteria. Over the 2 to 6-year follow-up, (mean time: 3.4 ± 1.5 years), the disease resolution rate was 83% (patient level) and 87% (implant level). Four implants (13%) were lost or removed due to continuous MBL and osseointegration failure. At follow-up, peri-implant marginal bone remained stable with no further bone loss in 87% of the treated implants. BOP was absent in 89.3% (implant level), suppuration was resolved in all cases, and no pain or implant fracture was reported. CONCLUSION Implantoplasty treated cases showed high disease resolution rate and peri-implant marginal bone stability. This surgical antibiofilm strategy can counteract peri-implantitis progression providing an adequate environment for implant function and longevity over a moderate to long-term period.
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Affiliation(s)
- Marco A Bianchini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, South Carolina, Brazil
| | - Maria E Galarraga-Vinueza
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, South Carolina, Brazil.,Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
| | - Karin Apaza-Bedoya
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, South Carolina, Brazil
| | - Jose M De Souza
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, South Carolina, Brazil
| | - Ricardo Magini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, South Carolina, Brazil
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany
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