Successful Management of Early Peri-Implant Infection and Bone Loss Using a Multidisciplinary Treatment Approach

Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis

Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2-11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = -1.10 mm, 95% confidence interval -1.97 to -0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

The uses of implantable medical devices are safer and more common since sterilization methods and techniques were established a century ago; however, device-associated infections (DAIs) are still frequent and becoming a leading complication as the number of medical device implantations keeps increasing. This urges the world to develop instructive prevention and treatment strategies for DAIs, boosting the studies on the design of antibacterial surfaces. Every year, studies associated with DAIs yield thousands of publications, which here are categorized into four groups, i.e., antibacterial surfaces with long-term efficacy, cell-selective capability, tailored responsiveness, and immune-instructive actions. These innovations are promising in advancing the solution to DAIs; whereas most of these are normally quite preliminary “proof of concept” studies lacking exact clinical scopes. To help identify the flaws of our current antibacterial designs, clinical features of DAIs are highlighted. These include unpredictable onset, site-specific incidence, and possibly involving multiple and resistant pathogenic strains. The key point we delivered is antibacterial designs should meet the specific requirements of the primary functions defined by the “intended use” of an implantable medical device. This review intends to help comprehend the complex relationship between the device, pathogens, and the host, and figure out future directions for improving the quality of antibacterial designs and promoting clinical translations.

Successful Management of Peri-Implantitis Using a Titanium Brush and a Doxycycline-Saline Slurry for Surface Detoxification With Guided Bone Regeneration: A 5-Year Follow-Up

INTRODUCTION

The inflammation associated with peri-implantitis lesions can be difficult to manage and regeneration of lost bone is unpredictable. Unfortunately, opinions vary on the best method(s) for elimination of inflammation and restoration of residual osseous defects. This report describes the successful surgical management of a peri-implantitis lesion with reduction of inflammation and maintenance of nearly completely regenerated horizontal and vertical bone over 5 years.

CASE PRESENTATION

A 55-year-old healthy, non-smoking, African-American female presented in 2013 with inflammation and >25% bone loss at implant site #18. Probing depths ranged from 6 to 13 mm with bleeding on probing (BOP). She was diagnosed with peri-implantitis. She reported a history of routine scaling every 6 months since implant and crown placement 3 years earlier (2010). Initial periodontal treatment consisted of non-surgical scaling and implant debridement. Deep pockets and BOP persisted at re-evaluation. Surgical treatment consisted of full thickness flap, soft tissue curettage with titanium curets, and detoxification of the implant surface with a doxycycline and sterile saline slurry using a titanium brush. Mineralized freeze-dried bone allograft and demineralized freeze-dried bone allograft in a 50:50 ratio was placed and covered with a resorbable collagen membrane. All postoperative visits were uneventful. Maximum probing depths around the treated implant at the 5+-year follow-up (2019) were 4 mm with no BOP and nearly complete bone fill.

CONCLUSIONS

This case illustrates that it is possible to successfully eliminate clinical inflammation associated with peri-implantitis, regenerate bone, and maintain health for >5 years.