Using the best available evidence to support clinical decisions in implant dentistry.
ABSTRACT The number of clinicians performing dental implant treatment has increased in recent years. Evidence-based information is necessary to support dentists' decision making. This study was undertaken to present a strategy for searching, selecting, and appraising scientific literature and applying the information in the clinical setting.
A focused question in the PICO format (patient, intervention, comparison, and outcome) was developed to optimize the literature search process. Systematic reviews (SRs) of randomized controlled trials (RCTs) on the treatment of peri-implantitis were retrieved from the PubMed and Cochrane electronic databases on January 1, 2009. The methodologic quality of the two SRs selected was assessed by two referees using three checklists (CASP, QUOROM, and AMSTAR). The level of agreement between the referees was determined by use of the intraclass correlation coefficient. The evidence retrieved served as the basis for development of a treatment algorithm.
The selected SRs reported that subgingival debridement, subgingival debridement plus use of antibiotics, and regenerative procedures can be effective treatments for peri-implantitis. Although the RCTs included in both SRs had several limitations, the checklists demonstrated that the SRs were methodologically rigorous. Intraclass correlation coefficients ranged from substantial to good, indicating that reviewers agreed in their assessment. The evidence-based algorithm visually illustrated the options for the management of peri-implantitis of different severity.
This scheme may help clinicians to understand research evidence and to apply it directly in a clinical setting.
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ABSTRACT: Several implant surface debridement methods have been reported for the treatment of peri-implantitis, however, some of them can damage the implant surface or promote bacterial resistance. Photodynamic therapy (PDT) is a new treatment option for peri-implantitis. The aim of this in vitro study was to analyze implant surface decontamination by means of PDT. Sixty implants were equally distributed (n = 10) into four groups and two subgroups. In group G1 there was no decontamination, while in G2 decontamination was performed with chlorhexidine. G3 (PDT - laser + dye) and G4 (laser, without dye) were divided into two subgroups each; with PDT performed for 3 min in G3a and G4a, and for 5 min in G3b and G4b. After 5 min in contact with methylene blue dye (G3), the implants were irradiated (G3 and G4) with a low-level laser (GaAlAs, 660 nm, 30 mW) for 3 or 5 min (7.2 and 12 J). After the dilutions, culture media were kept in an anaerobic atmosphere for 1 week, and then colony forming units were counted. There was a significant difference (p < 0.001) between G1 and the other groups, and between G4 in comparison with G2 and G3. Better decontamination was obtained in G2 and G3, with no statistically significant difference between them. The results of this study suggest that photodynamic therapy can be considered an efficient method for reducing bacteria on implant surfaces, whereas laser irradiation without dye was less efficient than PDT.Lasers in Medical Science 07/2012; 28(1). DOI:10.1007/s10103-012-1148-6 · 2.42 Impact Factor
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ABSTRACT: Objective: The aim of this review is to summarize the findings of studies that have evaluated non-surgical approaches for detoxification of implant body surfaces in vitro and in vivo, and to evaluate clinical trials on the use of these methodologies for treating peri-implant disease. Materials and methods: A literature search was conducted using MEDLINE (Pubmed) from 1966 to 2013. In vitro and in vivo studies as well as clinical trials on non-surgical therapy were evaluated. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters including probing depth, clinical attachment levels, bleeding on probing; radiographic bone fill and histological re-osseointegration. Results: From 134 articles found 35 were analyzed. The findings, advantages and disadvantages of using lasers as well as mechanical and chemical methods are discussed. Most of the in vivo and human studies used combination therapies which makes determining the efficacy of one specific method difficult. Most human studies are case series with short term longitudinal analysis without survival or failure reports. Conclusion: Complete elimination of the biofilms is difficult to achieve using these approaches. All therapies induce changes of the chemical and physical properties of the implant surface. Re-osseointegration may be difficult to achieve if not impossible without surgical access to ensure thorough debridement of the defect and detoxification of the implant surface. Combination protocols for non-surgical treatment of peri-implantitis in humans have shown some positive clinical results but long-term evaluation to evaluate the validity and reliability of the techniques is needed.The Open Dentistry Journal 05/2014; 8(1):77-84. DOI:10.2174/1874210601408010077
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ABSTRACT: Purpose. Peri-implantitis is one of the major causes of implant failure. The detoxification of the implant surface is necessary to obtain reosseointegration. The aim of this review was to summarize in vitro and in vivo studies as well as clinical trials that have evaluated surgical approaches for detoxification of the implant body surfaces. Materials and Methods. A literature search was conducted using MEDLINE (PubMed) from 1966 to 2013. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters, radiographic bone fill, and histological reosseointegration. Results. From 574 articles found, 76 were analyzed. The findings, advantages, and disadvantages of using mechanical, chemical methods and lasers are discussed. Conclusions. Complete elimination of the biofilms is difficult to achieve. All therapies induce changes of the chemical and physical properties of the implant surface. Partial reosseointegration after detoxification has been reported in animals. Combination protocols for surgical treatment of peri-implantitis in humans have shown some positive clinical and radiographic results, but long-term evaluation to evaluate the validity and reliability of the techniques is needed.International Journal of Dentistry 08/2013; 2013:740680. DOI:10.1155/2013/740680