Treatment of peri-implantitis: what interventions are effective? A Cochrane systemic review

Department of Biomaterials, The Sahlgrenska Academy at Göteborg University, Sweden.
European Journal of Oral Implantology (Impact Factor: 3.14). 07/2012; 5 Suppl(supplement):S21-41.
Source: PubMed


To identify the most effective interventions for treating peri-implantitis around osseointe-grated oral implants.
The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched up to the 9th of June 2011 for randomised controlled trials (RCTs) comparing agents or interventions for treating peri-implantitis around oral implants. Primary outcome measures were implant failure, radiographic marginal bone level change, complications and side effects, and recurrence of peri-implantitis. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. The statistical unit was the patient and not the implant unless the clustering of the implants within the patients had been taken into account. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI).
Fifteen eligible trials were identified, but six were excluded. The following interventions were compared in the nine included studies: different non-surgical interventions (five trials), adjunctive treatments to non-surgical interventions (one trial), and different surgical interventions (two trials) and adjunctive treatments to surgical interventions (one trial). Follow-up ranged from 3 months to 4 years. No study was judged to be at low risk of bias. Statistically significant differences were observed in two small single trials judged to be at unclear or high risk of bias. After 4 months, adjunctive local antibiotics to manual debridement in patients who lost at least 50% of the bone around implants showed improved mean probing attachment levels (PAL) of 0.61 mm (95% CI 0.40 to 0.82) and reduced probing pockets depths (PPD) of 0.59 mm (95% CI 0.39 to 0.79). After 4 years, patients with periimplant infrabony defects >3 mm treated with Bio-Oss and resorbable barriers showed an improvement of 1.4 mm for PAL (95% CI 0.24 to 2.56) and PPD (95% CI 0.81 to 1.99) compared to patients treated with a nanocrystalline hydroxyapatite.
There is no reliable evidence suggesting which could be the most effective interventions for treating peri-implantitis. This is not to say that currently used interventions are not effective. A single small trial at unclear risk of bias showed that the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement in PAL and PPD over a 4-month period in patients affected by severe forms of peri-implantitis. Another small single trial at high risk of bias showed that after 4 years, improved PAL and PPD of about 1.4 mm were obtained when using Bio-Oss with resorbable barriers compared to a nanocrystalline hydroxyapatite in peri-implant infrabony defects. There is no evidence from four trials that the more complex and expensive therapies were more beneficial than the control therapies, which basically consisted of simple subgingival mechanical debridement. Follow-up longer than 1 year suggested recurrence of peri-implantitis in up to 100% of the treated cases for some of the tested interventions. As this can be a chronic disease, re-treatment may be necessary. Larger well-designed RCTs with follow-ups longer than 1 year are needed.

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    • "Surgical techniques are also used in the treatment of peri-implantitis, with the rationale that surgery grants increased access to the spaces inhabited by deleterious bacteria [13] [14]. However, strong evidence supporting any particular therapy in the treatment of peri-implantitis has yet to be established [13] [14]. In light of this, we attempted to treat a case of peri-implantitis using a topical desiccant (HYBENX Oral Tissue Decontaminant, EPIEN Medical, "
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    ABSTRACT: Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. Based on the results described within, we conclude that the use of HYBENX and air powder abrasives, followed by bone defect grafting, represents a viable option in the treatment of peri-implantitis.
    Full-text · Article · May 2015
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    • "00, 2014, 1–6 doi: 10.1111/clr.12530 peri-implantitis (Esposito et al. 2012) and many studies have shown that non-surgical mechanical treatment can successfully heal peri-implant mucositis (Renvert et al. 2008). The European Federation of Periodontology review on peri-implant disease has reported that non-treated peri-implant mucositis can evolve in peri-implantitis, therefore it is important to treat early signs of peri-implant inflammation to prevent or limit marginal bone loss using appropriate instruments in professional plaque control and biofilm removal (Klinge & Meyle 2012). "
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    ABSTRACT: Objectives The aim of this study was to compare the efficacy of different instruments on biofilm removal from implant supported restorations.Materials and methodsThe study was designed as comparative multicenter clinical study including patients proceeding from the Milan, Naples, and Buenos Aires, with a peri-implant mucositis.Implants enrolled for the study were allocated in 4 groups and treated with ultrasonic scalers with plastic tips, with titanium curettes, with airflow with glycine powder, and with rubber cup and polishing paste, respectively.mPI was assessed at baseline, immediately after therapy, at 1, 3, and 6 months. mBI, PD, and REC were assessed at baseline, 1, 3, and 6 months. All parameters were recorded on six sites per implant.Kruskal–Wallis and Mann–Whitney tests were used to compare groups and centers. A generalized linear model for repeated measures was chosen for inter-group comparison. An intra-group comparison was performed with repeated measure ANOVA test to assess differences between baseline and recalls.ResultsA total of 89 patients (39 males, 50 females) were enrolled in the study, and 141 implants were available for the analysis. 55 implants were enrolled in University of Buenos Aires, 32 in University of Milan, and 54 in University of Naples. There were no significant differences between the four groups in inflammatory status reduction of peri-implant mucosa.Conclusions Non-surgical therapy is effective in reducing peri-implant mucositis. Sonic scaler with plastic tip and rubber cup with polishing paste showed higher efficacy when compared with titanium curettes or airflow with glycine powder.
    Full-text · Article · Dec 2014 · Clinical Oral Implants Research
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    • "morse cone-connection) minimizing bacterial filtration- although due to the impossibility of completely eliminating bacterial contamination, subgingival plaque formation is still a problem which often result in peri-implantitis; and ii) treatment based on mechanical debridation, antibiotic treatment and osseous regeneration when possible [6]. The use of local antibiotics and antiplaque biocides, in addition to manual debridement seems to be an adequate treatment [7], [8]. However, it seems that the eradication of resistance is impossible and development of resistance to any particular antibiotic is inevitable. "
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    ABSTRACT: The aim of the present study was to evaluate bone loss at implants connected to abutments coated with a soda-lime glass containing silver nanoparticles, subjected to experimental peri-implantitis. Also the aging and erosion of the coating in mouth was studied. Five beagle dogs were used in the experiments. Three implants were placed in each mandible quadrant: in 2 of them, Glass/n-Ag coated abutments were connected to implant platform, 1 was covered with a Ti-mechanized abutment. Experimental peri-implantitis was induced in all implants after the submarginal placement of cotton ligatures, and three months after animals were euthanatized. Thickness and morphology of coating was studied in abutment cross-sections by SEM. Histology and histo-morphometric studies were carried on in undecalfied ground slides. After the induced peri-implantitis: 1.The abutment coating shown losing of thickness and cracking. 2. The histometry showed a significant less bone loss in the implants with glass/n-Ag coated abutments. A more symmetric cone of bone resorption was observed in the coated group. There were no significant differences in the peri-implantitis histological characteristics between both groups of implants. Within the limits of this in-vivo study, it could be affirmed that abutments coated with biocide soda-lime-glass-silver nanoparticles can reduce bone loss in experimental peri-implantitis. This achievement makes this coating a suggestive material to control peri-implantitis development and progression.
    Full-text · Article · Jan 2014 · PLoS ONE
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