Article

In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach

Authors:
  • Center of Dental Medicine - University of Zurich
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Abstract

Objectives: To assess the cleaning potential of commonly used implant debridement methods, simulating non-surgical peri-implantitis therapy in vitro. Materials and methods: One-hundred-and-eighty dental implants were ink-stained and mounted in combined soft and hard tissue models, representing peri-implantitis defects with angulations of 30, 60, and 90° covered by a custom-made artificial mucosa. Implants were treated by a dental school graduate and a board-certified periodontist for 120 s with following instruments: Gracey curette, ultrasonic scaler, and an air powder abrasive device with a nozzle for sub-mucosal use utilizing glycine powder. All procedures were repeated 10 times for each instrumentation and defect morphology respectively. Images of the implant surface were taken. Areas with color remnants were planimetrically determined and their cumulative surface area was calculated. Results were tested for statistical differences using two-way anova and Bonferroni correction. Micro-morphologic surface changes were analyzed on scanning electron microscope (SEM) images. Results: The areas of uncleaned surfaces (%, mean ± standard deviations) for curettes, ultrasonic tips, and air abrasion accounted for 74.70 ± 4.89%, 66.95 ± 8.69% and 33.87 ± 12.59% respectively. The air powder abrasive device showed significantly better results for all defect angulations (P < 0.0001). SEM evaluation displayed considerable surface alterations after instrumentation with Gracey curettes and ultrasonic devices, whereas glycine powder did not result in any surface alterations. Conclusion: A complete surface cleaning could not be achieved regardless of the instrumentation method applied. The air powder abrasive device showed a superior cleaning potential for all defect angulations with better results at wide defects.

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... Due to the major role of microorganisms in the etiology of peri-implant diseases, the primary goal of any treatment is to remove the bacterial biofilm from the surface of the dental implant. Results for biofilm removal with different techniques suggest that none of the currently used methods is sufficiently effective or superior to the others [18][19][20]. A limited effectiveness of these methods is likely due to inaccessible sites that cannot be reached directly during the therapy (i.e., due to inappropriate angle and working distance of the device tip). ...
... Although complete removal of the biofilm was not possible chemically or photoacoustically, the obtained results, nevertheless, compare favorably with the published results of similar studies using curettes, ultrasound, or blasting for implant surface cleaning. For example, Ronay et al. (2017) found that uncleaned areas for curettes, ultrasonic tips, and air abrasion treatments accounted for 75, 67, and 34% respectively [19]. Similarly, Sahrmann et al. (2015) reported that the uncleaned areas for curettes, ultrasonic tips, and airflow accounted for 24, 19, and 11%, respectively [18]. ...
... Although complete removal of the biofilm was not possible chemically or photoacoustically, the obtained results, nevertheless, compare favorably with the published results of similar studies using curettes, ultrasound, or blasting for implant surface cleaning. For example, Ronay et al. (2017) found that uncleaned areas for curettes, ultrasonic tips, and air abrasion treatments accounted for 75, 67, and 34% respectively [19]. Similarly, Sahrmann et al. (2015) reported that the uncleaned areas for curettes, ultrasonic tips, and airflow accounted for 24, 19, and 11%, respectively [18]. ...
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Article
Biofilms that grow on implant surfaces pose a great risk and challenge for the dental implant survival. In this work, we have applied Er:YAG photoacoustic irrigation using super short pulses (Er:YAG-SSP) to remove biofilms from the titanium surfaces in the non-contact mode. Mature Enterococcus faecalis biofilms were treated with saline solution, chlorhexidine, and hydrogen peroxide, or photoacoustically with Er:YAG-SSP for 10 or 60 s. The number of total and viable bacteria as well as biofilm surface coverage was determined prior and after different treatments. Er:YAG-SSP photoacoustic treatment significantly increases the biofilm removal rate compared to saline or chemically treated biofilms. Up to 92% of biofilm-covered surface can be cleaned in non-contact mode during 10 s without the use of abrasives or chemicals. In addition, Er:YAG-SSP photoacoustic irrigation significantly decreases the number of viable bacteria that remained on the titanium surface. Within the limitations of the present in vitro model, the ER:YAG-SSP seems to constitute an efficient therapeutic option for quick debridement and decontamination of titanium implants without using abrasives or chemicals.
... surface morphology with an individual surface roughness remain difficult to clean in daily routine even with good insight and improved accessibility [15,16]. Rigid instruments such as curettes and (ultra)sonic scalers with steel tips have recently failed to convince in both non-surgical and surgical simulated in vitro experiments [17][18][19]. Although these in vitro results seem clear, current clinical evidence does not show clear data for or against the use of these instruments [20]. ...
... The use of air-polishing with glycine powder has proven to be superior in both the surgical [17,19] and the non-surgical [18] in vitro approach compared to steel curettes and (ultra)sonic scaler with steel tips. Consequently, this study aims to compare different air-polishing methods in both approaches for three defect configurations [30°, 60°(intraosseous defects), 90°( supraosseous defect)] in order (i) to expand the available data on efficacy of surgical and non-surgical air-polishing application and (ii) to compare the efficacy of different air-polishing devices in both, a surgical and non-surgical in vitro simulation. ...
... The study was largely based on the set-up by Ronay et al. [18] and also follows approaches from Sahrmann et al. [19] and Keim et al. [17]. ...
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Article
Objectives Evaluation of surgical and non-surgical air-polishing in vitro efficacy for implant surface decontamination.Material and methodsOne hundred eighty implants were distributed to three differently angulated bone defect models (30°, 60°, 90°). Biofilm was imitated using indelible red color. Sixty implants were used for each defect, 20 of which were air-polished with three different types of glycine air powder abrasion (GAPA1–3) combinations. Within 20 equally air-polished implants, a surgical and non-surgical (with/without mucosa mask) procedure were simulated. All implants were photographed to determine the uncleaned surface. Changes in surface morphology were assessed using scanning electron micrographs (SEM).ResultsCleaning efficacy did not show any significant differences between GAPA1–3 for surgical and non-surgical application. Within a cleaning method significant (p < 0.001) differences for GAPA2 between 30° (11.77 ± 2.73%) and 90° (7.25 ± 1.42%) in the non-surgical and 30° (8.26 ± 1.02%) and 60° (5.02 ± 0.84%) in the surgical simulation occurred. The surgical use of air-polishing (6.68 ± 1.66%) was significantly superior (p < 0.001) to the non-surgical (10.13 ± 2.75%). SEM micrographs showed no surface damages after use of GAPA.Conclusions Air-polishing is an efficient, surface protective method for surgical and non-surgical implant surface decontamination in this in vitro model. No method resulted in a complete cleaning of the implant surface.Clinical relevanceAir-polishing appears to be promising for implant surface decontamination regardless of the device.
... Some studies suggest the use of plastic tips for handscalers and ultrasonic instruments for plaque removal due to their less structural damage in implants and components in comparison to metallic instruments. [11,12,[15][16][17] Using scanning electron microscopy it has been reported that the use of metal hand scalers is capable of damaging the titanium surface [6,17] so that results of surface roughness by optical profilometry demonstrate greater depth and width of the defects caused by the instrumentation performed with these hand scalers compared to plastic hand scalers. [15] In spite of this, there are no reports in the literature of the residual stresses generated between the friction of the implant surface and the different instrument tips, which could aid in visualizing mechanical problems and in preventing plastic deformations. ...
... Some studies suggest the use of plastic tips for handscalers and ultrasonic instruments for plaque removal due to their less structural damage in implants and components in comparison to metallic instruments. [11,12,[15][16][17] Using scanning electron microscopy it has been reported that the use of metal hand scalers is capable of damaging the titanium surface [6,17] so that results of surface roughness by optical profilometry demonstrate greater depth and width of the defects caused by the instrumentation performed with these hand scalers compared to plastic hand scalers. [15] In spite of this, there are no reports in the literature of the residual stresses generated between the friction of the implant surface and the different instrument tips, which could aid in visualizing mechanical problems and in preventing plastic deformations. ...
... Despite this, the results of the present study serve to illustrate how two-hand scalers indicated for the same treatment and with the same contact force can induce different results in the implant. As the literature already reports the full capacity for prophylaxis with plastic hand scalers, [7,[11][12][13]15,17] it is clear that its indication is less harmful for use on delicate surfaces. However, the present study did not simulate a Titanium [22] 110 0.35 Lithium disilicate [23] 95 0.30 Resin cement [24] 5.1 0.27 Medullar bone [25] 1.37 0.30 Cortical bone [25] 13.7 0.30 Teflon [26] 0.3 0.41 Steel [27] 200 0.33 series of oscillatory movements, such as what was promoted by using an ultrasonic device. ...
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Article
Background Mechanical scaling is the most common treatment of periodontal and peri-implant tissue infections. Aims This study aimed to evaluate the effect of mechanical prophylactic therapy on the residual stresses in the implant and hand scaler. Settings and Design For finite-element analysis, an implant-supported prosthesis was created using modeling software with 3 mm of exposed threads. For simulation of a prophylactic mechanical debridement, the active face of the shank was disposed of in contact with the last thread exposed at a 90° angle. Materials and Methods In the analysis software, the contacts were defined as rough between the instrument and the implant. The cortical bone was fixed and a load of 10 N was applied to the instrument cable. Two simulations were performed according to the instrument material: stainless steel or Teflon. Von-Mises results were obtained. Statistical Analysis Used No statistical test was used, but, the 500 higher stress peaks in the implant and in the instrument were analyzed for qualitative comparison. Results Mechanical prophylactic therapy generates higher residual stress on the implant with a stainless steel instrument. There was no difference between the materials for the active tip of the instrument, and the active portion of the shank was the region which concentrated more stress. Conclusions It is suggested that hand scalers in Teflon are less damaging to the implant, but more susceptible to deformation and possible early failures.
... Two recent in vitro studies investigated the cleaning efficacy of common instruments typically applied during surgical and non-surgical implant debridement [16,17]. The results of these investigations showed that regardless of the instrumentation technique used, the overall percentage of residual uncleaned surface was remarkably high. ...
... Details on the data collection can be found in the original publications, which examined the surgical (SA) and nonsurgical (NSA) implant debridement approaches on two different implant systems [16,17]. All analyses for the present study were performed on photographs previously taken in the course of the respective studies. ...
... For the imitation of the non-surgical approach, SPI Element RC Inicell® implants (Thommen Medical, Grenchen, Switzerland, length: 11 mm, endosseous diameter: 4.2 mm) with a mean roughness of the endosseous surface of 2.35 ± 0.25 μm were used [17]. Implants were mounted in the same way as described above, butwere additionally covered by a non-transparent custom-made mucosa mask (opaque gelatine; gelatine ballistic type 1, Gelita, Eberbach, Germany). ...
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Article
Background An in vitro model for peri-implantitis treatment was used to identify areas that are clinically difficult to clean by analyzing the pattern of residual stain after debridement with commonly employed instruments. Methods Original data from two previous publications, which simulated surgical (SA) and non-surgical (NSA) implant debridement on two different implant systems respectively, were reanalyzed regarding the localization pattern of residual stains after instrumentation. Two blinded examiners evaluated standardized photographs of 360 initially ink-stained dental implants, which were cleaned at variable defect angulations (30, 60, or 90°), using different instrument types (Gracey curette, ultrasonic scaler or air powder abrasive device) and treatment approaches (SA or NSA). Predefined implant surface areas were graded for residual stain using scores ranging from one (stain-covered) to six (clean). Score differences between respective implant areas were tested for significance by pairwise comparisons using Wilcoxon-rank-sum-tests with a significance level α = 5%. Results Best scores were found at the machined surface areas (SA: 5.58 ± 0.43, NSA: 4.76 ± 1.09), followed by the tips of the threads (SA: 4.29 ± 0.44, NSA: 4.43 ± 0.61), and areas between threads (SA: 3.79 ± 0.89, NSA: 2.42 ± 1.11). Apically facing threads were most difficult to clean (SA: 1.70 ± 0.92, NSA: 2.42 ± 1.11). Here, air powder abrasives provided the best results. Conclusion Machined surfaces at the implant shoulder were well accessible and showed least amounts of residual stain. Apically facing thread surfaces constituted the area with most residual stain regardless of treatment approach.
... Furthermore, recent studies have shown that the effectiveness of major debridement methods is strictly dependent on factors related to both the structure of the defect and the morphology of the implant, such as the width, depth, and angulation of the defect, and the shape, depth, and distance between the threads of the implant [17,20,24,25]. In this regard, the recent study by Sanz-Martín et al. [23] showed that the percentage of residual ink stains on the implant surface was lower when the implant was treated with mechanical tools. ...
... The relatively minimal results achieved by the use of erythritol may be related to the size of the particles (14 μm), which may not be as abrasive to remove the ink layer as those of glycine (about 25 μm). Other studies have tested glycine application, showing encouraging results [16,23,25]. In accordance with these studies, in our study, G-Air seems to have displayed good efficacy in removing ink, even though residual stains may be present, especially in the apical part of the defect and in the narrowest defects (i.e., 30°). ...
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Article
Various methods have been proposed to achieve the nearly complete decontamination of the surface of implants affected by peri-implantitis. We investigated the in vitro debridement efficiency of multiple decontamination methods (Gracey curettes [GC], glycine air-polishing [G-Air], erythritol air-polishing [E-Air] and titanium brushes [TiB]) using a novel spectrophotometric ink-model in 3 different bone defect settings (30°, 60°, and 90°). Methods: Forty-five dental implants were stained with indelible ink and mounted in resin models, which simulated standardised peri-implantitis defects with different bone defect angulations (30°, 60°, and 90°). After each run of instrumentation, the implants were removed from the resin model, and the ink was dissolved in ethanol (97%). A spectrophotometric analysis was performed to detect colour remnants in order to measure the cumulative uncleaned surface area of the implants. Scanning electron microscopy images were taken to assess micromorphological surface changes. Results: Generally, the 60° bone defects were the easiest to debride, and the 30° defects were the most difficult (ink absorption peak: 0.26±0.04 for 60° defects; 0.32±0.06 for 30° defects; 0.27±0.04 for 90° defects). The most effective debridement method was TiB, independently of the bone defect type (TiB vs. GC: P<0.0001; TiB vs. G-Air: P=0.0017; TiB vs. GE-Air: P=0.0007). GE-Air appeared to be the least efficient method for biofilm debridement. Conclusions: T-brushes seem to be a promising decontamination method compared to the other techniques, whereas G-Air was less aggressive on the implant surface. The use of a spectrophotometric model was shown to be a novel but promising assessment method for in vitro ink studies. Keywords: Air flow; Decontamination
... These changes may affect the subsequent proliferation of soft and hard tissue cells and promote bacterial recolonisation 17 . Different decontamination methods and devices have been tested in in vitro investigations, and the presence of residual biofilm after instrumentation was a frequent finding [18][19][20] . ...
... AA using SB has been shown to achieve complete decontamination on Streptococcus sanguinis 61 (which is claimed to be one of the earliest biofilm colonisers) and using glycine on other bacteria 62 . On the other hand, when comparing AA with other decontamination methods, such as lasers, several studies have reported that it performs better or equally well 18,63,64 . More recently, a study found that AA removed most of the bacteria from rough surface pits effectively, whereas saline rinsing left numerous coccoid bacteria despite the removal of the thick layer of biofilm 65 . ...
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Article
Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria's organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes.
... In the study by Ronay et al., (2017) implants were also stained for decontamination using a Gracey curette, an ultrasonic scaler and an air-powder abrasive device with a submucosal nozzle using glycine powder to evaluate the cleaning potential of commonly used implant debridement methods, simulating non-surgical peri-implantitis therapy in vitro. It was observed that the air-powder abrasive device showed significantly better results for all defect angulations. ...
... It was observed that the air-powder abrasive device showed significantly better results for all defect angulations. In addition, scanning electron microscopic evaluation showed considerable surface alterations after instrumentation with Gracey curettes and ultrasonic devices, whereas the glycine powder did not produce any surface alterations [28]. ...
Article
Background: the prognosis of peri-implant surgery can be affected by poor decontamination of the implant surface, which could be improved with the use of titanium brushes. The objectives of this systematic review were to evaluate the effectiveness of titanium brushes in the decontamination of the implant surface in terms of plaque index, probing depth, bleeding on probing and bone loss/gain; as well as its effectiveness according to the type of peri-implant bone defect. Methods: an electronic search was carried out in the PubMed, Scopus, Cochrane and Embase databases, as well as a manual search. The search strategy included four keywords: "Peri-implantitis", "Periimplantitis", "Implant Surface Decontamination" and "Titanium Brush". Randomized controlled studies published in the last 10 years were included and systematic reviews, in vitro studies and animal studies were excluded. Results: 142 references were found, from which only four articles met the inclusion criteria. All of the studies included in the present review reported beneficial results in terms of probing depth, gingival index and radiographic bone loss and gain after implant surface decontamination adjuvated by titanium brushes. Conclusions: titanium rotary brushes show improvements in the evolution and prognosis of peri-implant surgery, although more long-term studies are needed to draw more solid conclusions.
... The defect height in each model was 6 mm (down to the 3rd thread) and the defect width corresponded to the implant diameter (3.75 mm) simulating a semi-circumferential peri-implant defect. Implants, 13 mm in length with a diameter of 3.75 mm (Rapid Implant, Mode Dental Implants, Istanbul, Turkey), were dipcoated with permanent ink [18][19][20] (Staedtler permanent Lumocolor, Germany) to simulate an optically identifiable plaque accumulation over the complete rough titanium (65% hydroxyapatite + 35% calcium phosphate) surface. Implants were inserted into the study models in such a way that the rough surfaces leveled with the upper edge of the model [18]. ...
... The results obtained in this study with the air abrasive device were better than the ones with the Er:YAG laser; however both applications did not provide complete accessibility to the base of the defects. Although the implant and the defect type (circumferential) as well as the assessment methods were different in the aforementioned studies [18,20,40], the same model of surface ink staining representing the microbial plaque biofilm was used [15,[18][19][20]40]. Ink staining may be more recalcitrant in removal or vice versa; however, the residual staining has the advantage of being easily detected in the direct photographic evaluation compared to biofilm assessment methods that require many area specific steps [48]. ...
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Article
The purpose of this in vitro pilot study was to investigate the cleaning capacity of an air abrasive device with trehalose powder on implant surfaces compared to Er:YAG laser application in two different bone defect angulations. Forty ink stained dental implants were mounted in epoxy resin models representing standardized peri-implant defects with two different angulations (30° and 60°). An air powder abrasive device with a nozzle tip designed for subgingival usage and Er:YAG laser were used. A blinded and calibrated examiner evaluated the standardized photographs of instrumented implant surfaces with image-processing software. Student’s t test was used for the paired evaluation of the total cleaning effects according to defect angulations. The results showed that there were residual stained surfaces on all implants regardless of the cleaning methods and defect angulations. The percentage of total area cleaned by the air powder device in both defect angulations was significantly higher than that achieved by the Er:YAG laser application (p < 0.05). The differences between the two defect angulations within each cleaning method were statistically non-significant. Although a complete surface cleanliness was not provided with both cleaning methods, the air abrasive device revealed a better performance than the Er:YAG laser. The residual stained surfaces, especially at the deepest side of the defects, regardless of the cleaning method, suggest that special cleaning care is needed at the base of the peri-implant defects.
... Therefore, alternatively non-contact approaches like the use of non-abrasive powders in powder abrasive devices [36] or diode lasers [37] might be beneficial [38]. The latter might also better overcome the problem of surface areas that remain inaccessible to ultrasonic tips, like areas under the windings of screw-shaped implants [12,39,40]. ...
... Previous studies, however, showed that biofilm removal is basically possible with ultrasonic tips [41] and that ultrasonic debridement may be part of a clinically successful mucositis treatment [42]. Ronay et al. revealed, however, in a series of vitro-studies that ultrasonic debridement even with steel tips is heavily limited especially in tight peri-implant defects on one hand and in the area under the threads of screw-shaped implants on the other hand [39,40]. Furthermore it should be considered that biofilm colonization itself might influence the abrasion process on the rough surfaces. ...
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Article
Background To assess the changes of implant surfaces of different roughness after instrumentation with ultrasonic-driven scaler tips of different materials. Methods Experiments were performed on two moderately rough surfaces (I—Inicell® and II—SLA®), one surface without pre-treatment (III) and one smooth machined surface (IV). Scaler tips made of steel (A), PEEK (B), titanium (C), carbon (D) and resin (E) were used for instrumentation with a standardized pressure of 100 g for ten seconds and under continuous automatic motion. Each combination of scaler tip and implant surface was performed three times on 8 titanium discs. After instrumentation roughness was assessed by profilometry, morphological changes were assessed by scanning electron microscopy, and element distribution on the utmost surface by energy dispersive X-ray spectroscopy. Results The surface roughness of discs I and II were significantly reduced by instrumentation with all tips except E. For disc III and IV roughness was enhanced by tip A and C and, only for IV, by tip D. Instrumentation with tips B, D and E left extensive residuals on surface I, II and III. The element analysis of these deposits proved consistent with the elemental composition of the respective tip materials. Conclusion All ultrasonic instruments led to microscopic alterations of all types of implants surfaces assessed in the present study. The least change of implant surfaces might result from resin or carbon tips on machined surfaces.
... This raises the question whether the efficacy of the individual decontamination methods depends on the morphology of the bony defect and the surface quality of the implant. Studies have already shown a superiority of air powder abrasion devices over other methods (Ronay, Merlini, Attin, Schmidlin, & Sahrmann, 2017;Sahrmann et al., 2015). Nevertheless, the data are not comprehensive and there are no comparable confirmatory studies with other implant systems and decontamination alternatives. ...
... Accordingly, as mentioned before, the accessibility of the implant surface played a role. This has already been demonstrated in other studies for the simulation of nonsurgical (Ronay et al., 2017) and surgical (Sahrmann et al., 2015) procedures. ...
Article
Objectives Evaluation of in‐vitro efficacy of 3 different implant‐surface decontamination methods in a peri‐implant bone defect model. Material and methods 180 implants were stained with indelible red color and distributed to standardized peri‐implant bone defect resin models with a circumferential defect angulation of 30°, 60° or 90° (supraosseous defect). Sixty implants were assigned to each type of defect. All implants were cleaned by the same examiner. For each type of defect 20 implants were cleaned for 2 minutes with one of 3 devices: curette (CUR), sonicscaler (SOSC) or air abrasion with glycine powder (APA). Thereafter photos were taken from both sides of each implant and the cumulative uncleaned implant surface area was measured by color recognition technique. Scanning electron micrographs (SEM) were examined to assess morphologic surface damages. Results The cleaning efficacy as percent (%) of residual color was significantly different for each of the 3 defect angulations (p < 0.001) for each treatment device: 30° CUR: 53.44% > SOSC: 19.69% > APA: 8.03%; 60° CUR: 57.13% > SOSC: 11.4% > APA: 0.13%; 90° CUR: 48.1% > SOSC: 13.07% > APA: 0.58%. The differences between the three different cleaning modalities within each defect type were also significant (p < 0.005). SEM micrographs showed no surface damages after the use of APA. Conclusion Air powder abrasion is the most efficient (APA > SOSC > CUR) and less surface damaging treatment modality for each defect angulation in this in‐vitro model. This article is protected by copyright. All rights reserved.
... Ronay et al. [159] compared three implant surface debridement methods: curettes, ultrasonic scaling and air-powder abrasion. The authors found that air-abrasion cleaned more surface area than the other methods and did not alter the titanium surface [159]. ...
... Ronay et al. [159] compared three implant surface debridement methods: curettes, ultrasonic scaling and air-powder abrasion. The authors found that air-abrasion cleaned more surface area than the other methods and did not alter the titanium surface [159]. Duarte et al. [160] evaluated bacterial adhesion on smooth and rough surfaces after decontamination with one of the following procedures: erbium-doped:yttrium, aluminium, and garnet (Er:YAG) laser, metal and plastic curettes and air-powder abrasion. ...
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Article
Implant surface characteristics, as well as physical and mechanical properties, are responsible for the positive interaction between the dental implant, the bone and the surrounding soft tissues. Unfortunately, the dental implant surface does not remain unaltered and changes over time during the life of the implant. If changes occur at the implant surface, mucositis and peri-implantitis processes could be initiated; implant osseointegration might be disrupted and bone resorption phenomena (osteolysis) may lead to implant loss. This systematic review compiled the information related to the potential sources of titanium particle and ions in implant dentistry. Research questions were structured in the Population, Intervention, Comparison, Outcome (PICO) framework. PICO questionnaires were developed and an exhaustive search was performed for all the relevant studies published between 1980 and 2018 involving titanium particles and ions related to implant dentistry procedures. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the selection and inclusion of the manuscripts in this review. Titanium particle and ions are released during the implant bed preparation, during the implant insertion and during the implant decontamination. In addition, the implant surfaces and restorations are exposed to the saliva, bacteria and chemicals that can potentially dissolve the titanium oxide layer and, therefore, corrosion cycles can be initiated. Mechanical factors, the micro-gap and fluorides can also influence the proportion of metal particles and ions released from implants and restorations.
... In-vitro application of air-polishing on micro-structured titanium surfaces and in simulated peri-implant defects seems to achieve a more successful biofilm removal when compared with various mechanical instrumentation means (i.e. plastic curettes and ultrasonic tips with chlorhexidine irrigation, Vector system) and lasers (Er:YAG and Er,Cr:YSGG) [16][17][18][19][20]. Air-polishing also grants higher osteoblast viability on titanium surface compared with hand and ultrasonic instrumentation [16,20] and Er:YAG laser [18]. ...
... Air-polishing with low abrasiveness powder is stepping in as a valid and mini-invasive instrument for the management of dental implants biofilm. The advantages reported in literature are the efficient removal of bacterial deposits respecting the treated titanium surface [16][17][18][19][20]23,24]. A recent review of the literature from Schwarz et al. [13] concluded that air-polishing can be successfully applied in mucositis cases as a mono-therapy and can improve the outcome of the treatment of peri-implantitis when combined with ultrasonic debridement. ...
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Preprint
Air-polishing with low abrasiveness powders is fats arising as a valid and mini-invasive instrument for the management of biofilm colonizing dental implants. The reported advantage is the efficient removal of plaque with respect of the titanium integrity. In the present study, we evaluated the in-situ plaque-removal and continual the post-treatment anti-bacterial efficacy of an innovative erythritol/chlorhexidine air-polishing powder and compared it with sodium bicarbonate. Two peri-implantitis-linked biofilm formers strains Staphylococcus aureus and Aggregatibacter actinomycetemcomitans were selected and used to infect titanium disks before and after the air-polishing treatment. Cells number and viability were assayed by colonies forming units (CFUs) count and metabolic-colorimetric (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) (XTT) assay. Air-polishing performed with either sodium bicarbonate or erythritol/chlorhexidine was effective in reducing bacteria biofilm viability and number onto pre-infected specimens, while erythritol/ chlorhexidine showed a higher post-treatment biofilm re-growth inhibition. Surface analysis via mechanical profilometry failed to show an increase in titanium roughness, regardless of the powder selected.
... A variety of chemical and/or mechanical methods have been tested for implant surface treatment, but none was found to be superior to others (4), and complete resolution of the disease is unlikely (5). Air powder abrasion has shown some advantages in terms of biofilm removal in some in vitro experiments (6)(7)(8)(9); however, complete surface cleaning has not been achieved irrespective of the nonsurgical (10) or surgical (11) approach. ...
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Article
Objectives The aim of this in vitro study was to compare the efficacy of chemical and mechanical methods for decontamination of titanium dental implant surfaces previously infected with polymicrobial biofilms in a model simulating a peri-implant defect. Furthermore, the effect of each decontamination protocol on MG-63 osteoblast-like cells morphology and adhesion to the treated implants was assessed. Background Peri-implantitis is a growing issue in dentistry, and evidence about implant surface decontamination procedures is lacking and inconclusive. Methods A total of 40 previously biofilm-contaminated implants were placed into a custom-made model simulating a peri-implant defect and randomly assigned to five treatment groups: (C) control (no treatment); (AW) air abrasion without any powder; (ESC) air abrasion with powder of erythritol, amorphous silica, and 0.3% chlorhexidine; (HBX) decontamination with a sulfonic/sulfuric acid solution in gel; and (HBX + ESC) a combination of HBX and ESC. Microbiological analysis was performed on five implants per treatment group, and the residual viable bacterial load measured in log 10 CFU/mL was counted for each bacterial strain and for the total number of colonies. The remaining three implants per group and three noncontaminated (NC) implants were used to assess surface biocompatibility using a scanning electron microscope and a backscattered electron microscope after seeding with MG-63 cells. Results A significant decontaminant effect was achieved using HBX or HBX + ESC, while no differences were observed among other groups. The percentage of implant surface covered by adherent MG-63 cells was influenced by the treatment method. Progressive increases in covered surfaces were observed in groups C, AW, ESC, HBX, HBX + ESC, and NC. Conclusions A combination of mechanical and chemical decontamination may provide more predictable results than mechanical cleaning alone.
... Метод ультразвуковой санации, хорошо зарекомендовавший себя в некоторых отраслях медицины [8][9][10][11][12], может стать решением данной проблемы. ...
Article
The purpose of the article is to determine rational modes for safe and effective ultrasound exposure in order to sanitation urological catheters. It is shown that using an amplitude-modulated or pulsed power supply mode, it is possible to achieve an increase in amplitude, i.e. to improve the quality of cleaning and reduce heat generation. As a result, to technological solutions for the initiation of an ultrasonic emitter have been proposed.
... In combination with the surgical access to the affected implant, different surface decontamination methods have been evaluated although none has shown clear advantage in the improvement of clinical outcomes [32,[34][35][36][37]. In vitro studies, however, have shown that air-polishing systems as compared to curettes, ultrasound tips, and titanium brushes result in a higher capacity for biofilm removal and, at the same time, for preserving the integrity of the implant surface [38][39][40][41]. ...
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Article
Background: The aim of this study, a prospective case series, was to evaluate the clinical, microbiological, and biochemical impact of the surgical treatment of peri-implantitis. Methods: Thirty subjects with diagnosis of peri-implantitis were treated following a surgical protocol including access flaps, surface decontamination with ultrasonics and glycine powder air-polishing, and systemic antibiotics. Disease resolution was defined by the composite outcome including presence of probing depths (PD) ≤5 mm, absence of bleeding on probing (BoP)/suppuration, and no additional radiographic bone loss (>1 mm). Regression analysis was used to evaluate the patient-, implant-, and prosthetic-related factors possibly influencing treatment outcomes. Results: Patients were evaluated at 6 months post treatment, demonstrating statistically significant reductions in PD (2.14 ± 1.07 mm) and increase in mucosal recession (1.0 ± 0.77 mm). Plaque, BoP, and suppuration were also reduced by 40.56%, 62.22%, and 7.78%, respectively. Disease resolution was achieved in 56.67% of patients. No significant changes were detected in microbiological parameters except for a significant reduction in proportions of Parvimonas micra. Similarly, the levels of the biomarker interleukin-8 in crevicular fluid were significantly lower at 6 months. Conclusions: The proposed surgical treatment of peri-implantitis demonstrated statistically significant clinical improvements although the impact on microbiological and biochemical parameters was scarce.
... The management of peri-implant diseases is similar to the treatment of periodontal diseases, except that the debridement instruments have to be coated with softer materials to avoid scratching the implant surface with metallic conventional instruments [20]. In vitro, less abrasive debridement instruments, such as airflow devices, have shown effective biofilm removal without scratching the implant surface [200]. The regenerative approaches for peri-implantitis also are similar to that for periodontitis which depend on using GTR with or without scaffold. ...
Chapter
Periodontium is an intricate complex system that consists of different types of tissues. There are several diseases that affect periodontium causing destruction and loss of its tissues. The goal for periodontal treatment is the reconstruction of the lost periodontal tissues. Periodontal regeneration is considered one of oral health care challenges, and it can depend on using nanostructured biomaterials. These nanostructured biomaterials simulate the microenvironment of the extracellular matrix (ECM) and act as a biomimetic platform to attract stem cells and stimulate their differentiation to specific lineages. There are different forms for nanostructured biomaterials such as nanofibers and nanoparticles. Nanofibers have a similar structure and size to those of the natural collagen seen in the ECM of periodontal tissues. This chapter gives a brief overview of periodontium and periodontal diseases. Moreover, it discusses the different strategies for periodontal therapy including periodontal tissue regeneration and the recent nanofibrous biomaterials that can be used for periodontal regeneration.KeywordsGuided tissue regenerationMembraneNanofibrousPeriodontal and peri-implant diseasesPeriodontiumScaffold
... Because bacterial biofilm is the cause of both periodontitis and peri-implantitis, the treatment for both is the same. 40,41 However, the success of peri-implantitis therapy is not commendable. Gaining a better understanding of the nature of peri-implant biofilm could contribute to the discovery of focused treatment strategies, improving the outcome of peri-implantitis management. ...
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Article
AIM: This systematic review aims to analyze the microbiological similarities and differences between diseased periodontal and peri-implant sulci based on the available literature evidence. MATERIALS AND METHODOLOGY: A comprehensive search was done in electronic databases such as PubMed, Google Scholar, Cochrane and hand search was made based on pre-determined eligibility criteria. Studies assessing the microbial profile obtained from biofilm samples collected from diseased periodontal and peri-implant sulci were selected after through screening. RESULTS: The selected 8 studies evaluated the differences in microbial profile in periodontitis and peri-implantitis. Five studies found a statistically significant variation in the microbial profile between periodontitis and peri-implantitis, while one study found no significant changes in the microbiology of inflammatory peri-implant and periodontal sites. In one of the two in situ studies, the structure of the transcription level and core species in the co-occurrence network was different in peri-implantitis, whereas the other in situ study found that the two diseases differed in terms of 16S rRNA-based taxonomic profiles but were similar in terms of functional genes, taxonomic and virulence factor mRNA profiles. CONCLUSION: According to existing studies, significant differences in the biofilm composition of diseased periodontal and peri-implant sulci were observed. Hence, periodontitis and peri-implantitis have diverse microbial characteristics.
... Recent reviews showed that the most commonly instruments used for implant surface debridement are curettes, ultrasonic devices and abrasive air polishers (5,6). Recent in vitro studies investigating implant debridement methods demonstrated that air-powder devices provided a superior cleaning potential compared to curettes or ultrasonic scalers (7). However, despite clinical studies have revealed significant improvements in probing depth, bleeding on probing, and microbiological tests when treating periimplantitis with glycine powder air-polishing (8)(9)(10) it is still argued that does not show superior results to other methods, such as manual curettes, ultrasonic scalers, and laser devices (9), and limited evidence regarding the effect of the non-surgical treatment in peri-implantitis on the improvement or stopping bone loss (11). ...
Article
Background: Non-surgical treatment of peri-implantitis includes a correct mechanical debridement of the implant surface to reduce the inflammation and recondition the soft tissues. The aim of the study was to evaluate the results of a single phase of non-surgical therapy by comparing the effect of curettes and ultrasounds versus curettes and abrasive air polisher (Air-Flow) in the peri-implant tissue conditions, and patient satisfaction. Material and methods: A double-blind randomized and controlled prospective clinical study was conducted on patients in peri-implant maintenance phase diagnosed of peri-implantitis treated in the Oral Surgery Unit of the Stomatology Department of the Faculty of Medicine and Dentistry of the University of Valencia, between September of 2017 and May of 2018. They were divided into 2 groups: Group 1: curettes and ultrasounds, and Group 2: curettes and Air-Flow. The clinical and radiological baseline parameters were evaluated after 3-weeks of treatment, as well as patient satisfaction. Results: The sample included 34 patients. Group 1 (17 patients, 38 implants) and Group 2 (17 patients, 32 implants). All the variables improved statistically significantly after treatment in both groups, with the exception of recessions and keratinized mucosa and bone loss that did not vary. When comparing both groups, the type of treatment did not influence the majority of the variables, with the exception of the plaque index (p=0.011) and modified bleeding index from the palatine (p=0.048), which reduced statistically significant in the group 2, as well as the patient satisfaction which was higher in the group 2 (p<0.001). Conclusions: An initial phase of non-surgical treatment achieves an improvement of the peri-implant clinical parameters, thought the method of debridement used seems not to influence. Key words:Peri-implantitis, peri-implant disease, non-surgical treatment, air-abrasive device, mechanical debridement.
... In any case, all previous studies and the current study agree that NST (with or without antimicrobials) is ineffective to completely resolve BoP around dental implants (De Waal et al., 2021;Nart et al., 2020;Stein et al., 2018). Factors that might account for the low success rates of NST for PI could be related to the inherent difficulties in removing the biofilm from the implant surfaces, to the type of instruments used to perform the debridement (ultrasonic and hand instruments vs. air-abrasive devices), and to the fact that no removal and cleaning or modification of the suprastructure was performed in conjunction with NST (de Avila et al., 2020;Ronay et al., 2017). ...
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Article
Objectives: To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI). Materials and methods: Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N=18) and a control group treated with NST alone (N=19). Clinical parameters were evaluated at 12 weeks post-treatment. The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP) and plaque. Data analysis was performed at patient level (one target site per patient). Results: All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction of PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs 1.47 ± 1.95 mm), however this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; thirty out of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD ≤5 mm, and absence of BoP and SoP. Conclusions: NST was able to reduce PIPD at implants with PI. The adjunctive use of systemic AMX and MTZ did not show statistically significant better results compared to NST alone. NST with or without antibiotics was ineffective to completely resolve inflammation around dental implants.
... AA systems appeared to be superior when analyzed in comparison to other mechanical methods. Specifically, Ronay et al 54 and Sahrmann et al 55 reported that the APA device with glycine powder performed better than the Gracey steel curette or ultrasonic device with a steel tip, although complete cleaning was not obtained with any of the evaluated methods. Gehrke et al 49 analyzed the removal of artificial calculus by Teflon Gracey curette (M1), titanium Gracey curette (M2), sodium bicarbonate blasting (M3), and ultrasonic scaler with a metal tip (M4) and observed superior surface cleaning of M3 on rough surfaces and of M1 in the case of machined titanium. ...
Article
Purpose: To achieve high plaque removal around peri-implant tissues, noninvasive cleaning methods that guarantee the long-term success and survival of titanium implants should be established. This systematic review aimed to systematically evaluate in vitro investigations assessing different treatment modalities to decontaminate titanium surfaces, with special focus on the most effective cleaning procedures. Materials and methods: PRISMA guidelines were adopted in an electronic search conducted through MEDLINE, Scopus, and Google Scholar databases to identify studies on mechanical, chemical, or laser decontamination modalities up to November 2019. Results: The search resulted in 326 articles; after removing duplicates and reading titles, abstracts, and full texts, 38 articles were ultimately processed for data extraction. Mechanical decontamination provided better results in comparison to laser and chemical procedures. Among mechanical modalities, air abrasion showed the best cleaning effectiveness. Conversely, upon comparison of the chemical methods, chlorhexidine demonstrated comparable results with all tested substances and even with photodynamic therapy. Among different lasers, the results showed that the diode was more promising compared with the other tested lasers. Conclusion: This review demonstrated that there is still no consensus on which technique performs better. However, mechanical decontamination yielded more favorable results than laser and chemical methods. This aspect would support the hypothesis that decontamination procedures adopted in a combination fashion, which includes mechanical procedures, may provide better clinical results than when used alone.
... 3,4 Since PI is caused by the accumulation of pathological bacterial biofilms, disinfection and decontamination of the affected implant surfaces is crucial. 5,6 Several methods for implant surface disinfection, including mechanical and chemical modalities, are currently used in the clinical setting. Mechanical methods such as titanium or plastic curettes, ultrasonic scalers, and air-powder abrasives are effective for the removal of biofilms. ...
... In order to improve the predictability of the reconstructive approach in the treatment of peri-implantitis, different decontamination methods and devices have been tested in in vitro investigations. The outcomes of these investigations demonstrated the presence of residual biofilm after instrumentation [16][17][18][19]. This residual stain (biofilm) was mainly found in difficult to reach areas, such as between threads and in the thread surfaces facing downwards. ...
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Article
Objective To assess the efficacy of three mechanical decontamination methods in four types of commercially available implants. Material and methods Ninety-six implants of four commercial brands with different designs (regarding thread depth and thread pitch) were soaked in a surrogate biofilm (ink) and air-dried. Circumferential standardized peri-implant defects with 6 mm in depth and 1.55 mm in width were custom-made with a 3D printer. Stained implants were inserted in the defects and instrumented with three different methods: a titanium brush (TNB), a metallic ultrasonic tip (IST) and an air abrasive (PF). Standardized photographs were taken vertically to the implant axis (flat view), and with angulations of 60° (upper view) and 120° (lower view) to the implant long axis. The percentage of residual stain (PRS) was calculated with the image analysis software. Scanning electron microscope evaluations were performed on the buccal aspect of the implants at the central level of the defect. Results The efficacy of PF was significantly inferior to the TNB and IST in all implant designs, while there were no significant differences between TNB and IST. IST showed significantly higher PRS in the implant with the highest thread pitch, while the TNB had the highest PRS in the implant with a marked reverse buttress-thread design. The micro-thread design had the lowest values of PRS for all decontamination methods. The apically facing threads represented the areas with highest PRS for all implant designs and decontamination methods. Conclusion Thread geometry influenced the access of the decontamination devices and in turn its efficacy. Implants with lower thread pitch and thread depth values appeared to have less residual staining. Clinical relevance Clinicians must be aware of the importance of thread geometry in the decontamination efficacy.
... Ronay et al. revealed, however, in a series of vitro-studies that ultrasonic debridement even with steel tips is heavily limited especially in tight peri-implant defects on one hand and in the area under the threads of screw-shaped implants on the other hand [36,37]. Furthermore it should be considered that bio lm colonization itself might in uence the abrasion process on the rough surfaces. ...
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Preprint
Background To assess the changes of implant surfaces of different roughness after instrumentation with ultrasonic-driven scaler tips of different materials. Methods Experiments were performed on two moderately rough surfaces (I – Inicell® and II – SLA®), one surface without pre-treatment (III) and one smooth machined surface (IV). Scaler tips made of steel (A), PEEK (B), titanium (C), carbon (D) and resin (E) were used for instrumentation with a standardized pressure of 100 g for ten seconds and under continuous automatic motion. Each combination of scaler tip and implant surface was performed three times on 8 titanium discs. After instrumentation roughness was assessed by profilometry. Morphological changes were assessed by scanning electron microscopy, and element distribution on the utmost surface by energy dispersive X-ray spectroscopy. Results The surface roughness of discs I and II were significantly reduced by instrumentation with all tips except E. For disc III and IV roughness was enhanced by tip A and C and, only for IV, by tip D. Instrumentation with tips B, D and E left extensive residuals on surface I, II and III. The element analysis of these deposits proved consistent with the elemental composition of the respective tip materials. Conclusion Instrumentation by ultrasonic-driven tips changes implant surfaces of different roughness significantly. The least change of implant surfaces might result from resin or carbon tips on machined surfaces.
... Current methods of cleaning the biofilm are either not effective at the microscopic level or they involve using metal hand or ultrasonic instruments that lead to a potentially damaged surface which could cause problems during re-osseointegration [12][13][14]. There is no system at present that removes the biofilm from implants effectively and safely [15,16]. ...
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Article
The use of cavitation for improving biofilm cleaning is of great interest. There is no system at present that removes the biofilm from medical implants effectively and specifically from dental implants. Cavitation generated by a vibrating dental ultrasonic scaler tip can clean biomaterials such as dental implants. However, the cleaning process must be significantly accelerated for clinical applications. In this study we investigated whether the cavitation could be increased, by operating the scaler in carbonated water with different CO2 concentrations. The cavitation around an ultrasonic scaler tip was recorded with high speed imaging. Image analysis was used to calculate the area of cavitation. Bacterial biofilm was grown on surfaces and its removal was imaged with a high speed camera using the ultrasonic scaler in still and carbonated water. Cavitation increases significantly with increasing carbonation. Cavitation also started earlier around the tips when they were in carbonated water compared to non-carbonated water. Significantly more biofilm was removed when the scaler was operated in carbonated water. Our results suggest that using carbonated water could significantly increase and accelerate cavitation around ultrasonic scalers in a clinical situation and thus improve biofilm removal from dental implants and other biomaterials.
... In in vitro studies, sodium bicarbonate showed to remove more than 84% of bacteria or bacterial products, even if it produced slight to medium surface changes, such as small crater-like defects, rounding, or removal of sharp edges [7]. Amino-acid glycine was also able to remove single bacterial species and plaque from smooth and structured titanium surfaces, and it was less abrasive than sodium bicarbonate powder [7,12,26,27]. The lower momentum and less energy at impact onto implant surface were due to the Fig. 2 Bar chart based on the log10 of mean CFU. ...
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Article
Objectives To compare, using an ex vivo model, the biofilm removal of three surface decontamination methods following surgical exposure of implants failed for severe peri-implantitis. Materials and methods The study design was a single-blind, randomized, controlled, ex vivo investigation with intra-subject control. Study participants were 20 consecutive patients with at least 4 hopeless implants, in function for >12 months and with progressive bone loss exceeding 50%, which had to be explanted. Implants of each patient were randomly assigned to the untreated control group or one of the three decontamination procedures: mechanical debridement with air-powder abrasion, chemical decontamination with hydrogen peroxide and chlorhexidine gluconate, or combined mechanical-chemical decontamination. Following surgical exposure, implants selected as control were retrieved, and afterwards, test implants were decontaminated according to allocation and carefully explanted with a removal kit. Microbiological analysis was expressed in colony-forming-units (CFU/ml). Results A statistically significant difference ( p < 0.001) in the concentrations of CFU/ml was found between implants treated with mechanical debridement (531.58 ± 372.07) or combined mechanical-chemical decontamination (954.05 ± 2219.31) and implants untreated (37,800.00 ± 46,837.05) or treated with chemical decontamination alone (29,650.00 ± 42,596.20). No statistically significant difference (p = 1.000) was found between mechanical debridement used alone or supplemented with chemical decontamination. Microbiological analyses identified 21 microbial species, without significant differences between control and treatment groups. Conclusions Bacterial biofilm removal from infected implant surfaces was significantly superior for mechanical debridement than chemical decontamination. Clinical relevance The present is the only ex vivo study based on decontamination methods for removing actual and mature biofilm from infected implant surfaces in patients with peri-implantitis.
... So far, several antiinfective protocols have been proposed to primarily clean and disinfect the exposed dental implant in the management of periimplantitis [9]. The usage of air polishing using glycine powder against biofilms at implants was already described in vitro and represents one of the most promising methods as compared to curette or sonic-scaler debridement [14,15]. A bacterial reduction of 99.9% on implant surfaces using different systems of air polishing has been shown [16]. ...
Full-text available
Article
Objectives To evaluate the effectiveness of mechanical debridement and/or air polishing on the healing of ligature-induced buccal periimplantitis dehiscence defects in dogs. Material and methods Forty-eight implants were placed in the mandibles of twelve beagle dogs, and periimplantitis was induced for 2 months using ligatures. The resulting buccal dehiscence-type defects were surgically cleaned and aug- mented (xenogenic filler and resorbable membrane) according to one of the following treatments: (1) Cleaning with carbon curette (debridement - D) and guided bone regeneration (GBR/G): DG, (2) air polishing cleaning (A) and GBR: AG, (3) a combination of D/A/G: DAG, and (4) D/A without GBR: DA. After 2 months, histomorphometric and inflammatory evaluations were conducted. Results The median bone gain after therapy ranged between 1.2 mm (DG) and 2.7 mm (AG). Relative bone gain was between 39% (DG) and 59% (AG). The lowest inflammation scores were obtained in DA without GBR (5.84), whereas significantly higher values between 8.2 and 9.4 were found in the groups with augmentation. At lingual sites without defects, scores ranged from 4.1 to 5.9. According to ISO, differences above 2.9 were considered representative for irritative properties. Conclusions All treatments resulted in partial regeneration of the defects. No treatment group showed a significantly (p < 0.05) better outcome. However, pretreatment with air polishing showed a tendency for less inflammation. Noteworthy, inflammation assessment showed an overall irritative potential after GBR in the evaluated early healing phase. Clinical relevance Periimplantitis treatment still represents a big issue in daily practice and requires additional preclinical research in order to improve treatment concepts.
... Nach Berglundh & Wennström können operative (resektive) Periimplantitisbehandlungen langfristig erfolgreich sein, jedoch scheint der Erfolg auch von der Oberflächen beschaffenheit der Implantate abzuhängen 10 . Die Oberflächeneigenschaften beeinflussen die Möglichkeit der vollständigen Dekontamination der Oberflächen, wie Ronay und Sahrmann zeigten 7,9 . Die Modifikation der Oberflächen in Form einer Implantoplastik wurde von mehreren Autoren vorgeschlagen 18−22 , wobei in allen Fällen selbst bei den In-vitro-Studien der kritische Rz-Wert oberhalb der Bakteriengröße lag. ...
Article
Today, implant treatment is part of routine dental therapy. In conjunction with the more frequent treatment, supportive care becomes increasingly important. Implants in patients with known risk factors may develop peri-implant inflammatory reactions, which is a challenging situation for the dentist and even the specialist. Among others, re- sective treatment concepts are of great importance. The advantage of these interventions is the pre- dictability of the outcome, which is an important prerequisite for the long-term success and stability of the peri-implant treatment. On the other hand, resective treatment is accompanied by esthetic shortcomings and is thus not an option in the esthetic zone. The concept is presented and illustrated through various clinical examples.
... Dental implants require maintenance over time to manage the formation of dental plaque [3]. Peri-implantitis is an inflammatory reaction with bone loss around the implant [4,5]. If the plaque is not removed it could eventually lead to implant failure [6,7] Dental plaque is a biofilm, a community of micro-organisms adhered to a surface [8]. ...
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Article
Effective biofilm removal from surfaces in the mouth is a clinical challenge. Cavitation bubbles generated around a dental ultrasonic scaler are being investigated as a method to remove biofilms effectively. It is not known how parameters such as surface roughness and instrument distance from biofilm affect the removal. We grew Strepotococcus sanguinis biofilms on coverslips and titanium discs with varying surface roughness (between 0.02–3.15 μm). Experimental studies were carried out for the biofilm removal using high speed imaging and image analysis to calculate the area of biofilm removed at varying ultrasonic scaler standoff distances from the biofilm. We found that surface roughness up to 2 μm does not adversely affect biofilm removal but a surface roughness of 3 μm caused less biofilm removal. The standoff distance also has different effects depending on the surface roughness but overall a distance of 1 mm is just as effective as a distance of 0.5 mm. The results show significant biofilm removal due to an ultrasonic scaler tip operating for only 2s versus 15-60s in previous studies. The technique developed for high speed imaging and image analysis of biofilm removal can be used to investigate physical biofilm disruption from biomaterial surfaces in other fields.
... In general, both therapeutic approaches show strong limitations. In particular, mechanical access for debridement of submucosal areas and narrow infra-bony defects is difficult and cannot be performed to a satisfactory extent [17,21,22]. Antimicrobial agents, on the other hand, are largely ineffective due to the immanent defense mechanisms of mature biofilms, such as osmotic barrier function and downregulation of bacterial metabolism [23], especially if the biofilm infrastructure had not been destroyed previously by mechanical means [24,25]. ...
Full-text available
Article
This review aimed to systematically compare microbial profiles of peri-implantitis to those of periodontitis and healthy implants. Therefore, an electronic search in five databases was conducted. For inclusion, studies assessing the microbiome of peri-implantitis in otherwise healthy patients were considered. Literature was assessed for consistent evidence of exclusive or predominant peri-implantitis microbiota. Of 158 potentially eligible articles, data of 64 studies on 3730 samples from peri-implant sites were included in this study. Different assessment methods were described in the studies, namely bacterial culture, PCR-based assessment, hybridization techniques, pyrosequencing, and transcriptomic analyses. After analysis of 13 selected culture-dependent studies, no microbial species were found to be specific for peri-implantitis. After assessment of 28 studies using PCR-based methods and a meta-analysis on 19 studies, a higher prevalence of Aggregatibacter actinomycetemcomitans and Prevotella intermedia (log-odds ratio 4.04 and 2.28, respectively) was detected in peri-implantitis biofilms compared with healthy implants. Actinomyces spp., Porphyromonas spp. and Rothia spp. were found in all five pyrosequencing studies in healthy-, periodontitis-, and peri-implantitis samples. In conclusion, the body of evidence does not show a consistent specific profile. Future studies should focus on the assessment of sites with different diagnosis for the same patient, and investigate the complex host-biofilm interaction.
... In vitro studies 82 have shown better implant surface cleaning with air-polishing, mainly in large peri-implant defects, but the clinical significance of this procedure has not yet been established. There is a consensus among the authors about the difficulty of achieving complete implant surface decontamination. ...
Full-text available
Article
Introduction: the incidence of peri-implant diseases is high, and their optimal management is still debated. The purpose was to explore the levels of available evidence and to suggest evidence-based recommendations for the treatment of peri-implant mucositis and peri-implantitis. Methods: a clinical practice guideline was developed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. A search strategy was formulated, and a critical review of the following evidence was performed: 1) prevention of peri-implant diseases, 2) treatment of peri-implant mucositis, and 3) treatment of peri-implantitis. Systematic reviews and randomized controlled clinical trials were the primary study types identified in the literature. Current levels of evidence were established and recommendations were provided. Results: a total of 67 articles were included. Regarding the prevention of peri-implant diseases, there is strong evidence for the involvement of patients in a regular maintenance program according to their risk profile. Regarding the treatment of peri-implant mucositis, infection control measures are recommended; controversy exists over the usefulness of antimicrobial agents, and there is evidence against the use of antibiotics. Selection of the peri-implantitis treatment method depends on the severity of the condition and patient-related factors. Resective and regenerative therapies may be used for treatment. The use of systemic antibiotics favors the response of clinical parameters. There is conditional evidence for the use of other adjunctive therapies. Conclusions: the best way to prevent peri-implantitis is to prevent peri-implant mucositis through adherence to supportive periodontal therapy. Treatment of peri-implant diseases depends on local and systemic conditions that affect the success of other treatment options.
... What is more, complex implant surface areas seem difficult to access by hand instrumentation [41]. Though air powder abrasives with glycine particles seem to be an alternative that is unproblematic for the titanium surface while reaching the major part of the submucosal area [42], the according device is not yet disposable in the greater part of the dental practices. Therefore, the decision for no mechanical debridement was taken for the study protocol. ...
Full-text available
Article
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.
... As for mechanical debridement efficacy, a number of studies have found air polishing to be more effective than curettes, ultrasonics, and lasers for subgingival implant surface debridement, and F I G U R E 2 Maintenance therapy after implant placement reduced the failure rate by 80% (P < 0.001) 82 F I G U R E 1 Poor oral hygiene associated with peri-implant mucositis to cause less damage to the implant surface. [84][85][86] Polishing with glycine powder is thought to be less damaging to implant surfaces than sodium bicarbonate. 87 A study of 6 months duration compared glycine powder polishing with manual scaling using a plastic curette and chlorhexidine for the treatment of peri-implant mucositis. ...
Full-text available
Article
This article summarizes the microbiological findings at dental implants, drawing distinctions between the peri‐implant microbiome and the periodontal microbiome, and summarizes what is known regarding biofilm as a risk factor for specific stages of implant treatment. Targeted microbial analysis is reviewed as well as the latest results from open‐ended sequencing of the peri‐implant flora. At this time there remains a lack of consensus for a specific microbial profile that is associated with peri‐implantitis, suggesting that there may be other factors which influence the microbiome such as titanium surface dissolution. Therapeutic interventions to address the biofilm are presented at the preoperative, perioperative, and postoperative stages. Evidence supports that perioperative chlorhexidine reduces biofilm‐related implant complications and failure. Regular maintenance for dental implants is also shown to reduce peri‐implant mucositis and implant failure. Maintenance procedures should aim to disrupt the biofilm without damaging the titanium dioxide surface layer in an effort to prevent further oxidation. Evidence supports the use of glycine powder air polishing as a valuable adjunct to conventional therapies for use at implant maintenance visits. For the treatment of peri‐implantitis, nonsurgical therapy has not been shown to be effective, and while surgical intervention is not always predictable, it has been shown to be superior to nonsurgical treatment for decontamination of the implant surface that is not covered by bone.
... 3), was sich negativ auf die Zellanhaftung einerseits und andererseits eine Rekolonialisierung durch Oralpathogenen Vorschub leisten kann. Zudem ist die Reinigungseffizienz -wie auch bei Ultraschallinstrumenten -aufgrund der Windungen und Zugänglichkeit erschwert und nicht als ausreichend zu bezeichnen (Steiger- Ronay et al., 2017;Mengel, Buns, Mengel, & Flores-de-Jacoby, 1998) ...
... Seven out of the 11 studies in this category were also presented in Section 3.4.1. 20,64,73,76,77,80 Results regarding cleaning efficacy were consistent, and all of the 11 studies reported that AA was superior to other decontamination methods or at least performed similarly to them. Four studies compared nonmechanical laser decontamination with AA and three concluded that AA cleaned better than laser. ...
Article
Background Air abrasion (AA) is one of the decontamination methods that have demonstrated promising results in treating peri‐implant diseases. Purpose This systematic review aimed at evaluating the in vitro effect of AA on surface change, cleaning efficacy, and biocompatibility of titanium surfaces and at comparing it with other decontamination methods. Materials and Methods A comprehensive search was conducted up to April 2018 using PubMed, Scopus, and Google Scholar databases to identify studies on the decontamination effect of AA. All types of titanium surfaces, abrasive powders, contaminated surfaces, and measuring methods were included. Results Overall, 1502 articles were identified. After screening the titles and abstracts, and carefully reading the full‐texts, 48 articles published between 1989 and 2018 were selected. AA was considered almost safe, particularly for the nonmodified surfaces. Nevertheless, harder powders such as sodium bicarbonate tended to damage the surface more than glycine. AA resulted in surface change similar to plastic curettes and Er: YAG lasers. Regarding the cleaning efficacy, there was no significant difference between glycine and sodium bicarbonate, but different mixtures of calcium phosphate, hydroxyapatite, and erythritol were superior to glycine. AA was superior or equal to all other decontamination methods in cleaning. Regarding biocompatibility, AA was more successful in preserving biocompatibility for noncontaminated surfaces compared with contaminated surfaces and when used with erythritol and osteoinductive powders. Conclusions AA can efficiently remove contamination without serious damage to the surface. The main drawback of the AA method seems to be its limitation in restoring the biocompatibility of the surface.
... The proper mechanical debridement protocol for the dental implant surface remains controversial. Ronay et al 276 assessed the cleaning potential of commonly used implant debridement methods, simulating nonsurgical peri-implantitis therapy in vitro. One hundred-andeighty dental implants were ink-stained and mounted in combined soft and hard tissue models, representing periimplantitis defects with angulations of 30, 60, and 90 degrees covered by a custom-made artificial mucosa. ...
Article
Problem: There are countless numbers of scientific studies published in countless scientific journals on subjects related to restorative dentistry. Purpose: The purpose of this article is to review pertinent scientific studies published in 2017 on topics of interest to restorative dentists. Methods and materials: The authors, considered to be experts in their disciplines searched the scientific literature in 7 different areas (prosthodontics, periodontics, dental materials, occlusion and temporomandibular disorders, sleep-disordered breathing, oral medicine and oral and maxillofacial surgery and dental caries). Pertinent articles were either identified and referenced or reviewed. Results: A total of 437 articles in 7 disciplines were identified or reviewed. Conclusions: An impressive amount of scientific literature related to restorative dentistry was published in 2017. The evidence presented in this article can assist dentists in the practice of contemporary evidence-based dentistry.
... Coming back to in situ biofilm removal techniques, air-polishing seems to constitute a valid tool for the supra-and sub-gingival management of biofilm at teeth and implants [20][21][22]. In-vitro application of air-polishing on micro-structured titanium surfaces and in simulated peri-implant defects seems to achieve a more successful biofilm removal when compared with various mechanical instrumentation means (e.g., plastic curettes and ultrasonic tips with chlorhexidine irrigation, the Vector system) and lasers (Er:YAG and Er,Cr:YSGG) [23][24][25][26][27]. Air-polishing also grants higher osteoblast viability on titanium surface compared with hand and ultrasonic instrumentation [23,27] and Er:YAG laser [25]. ...
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Air-polishing with low abrasiveness powders is fast arising as a valid and mini-invasive instrument for the management of biofilm colonizing dental implants. In general, the reported advantage is the efficient removal of plaque with respect to the titanium integrity. In the present study, we evaluated the in situ plaque removal and the preventive efficacy in forestalling further infection of an innovative erythritol/chlorhexidine air-polishing powder and compared it with sodium bicarbonate. Accordingly, two peri-implantitis-linked biofilm formers, strains Staphylococcus aureus and Aggregatibacter actinomycetemcomitans, were selected and used to infect titanium disks before and after the air-polishing treatment to test its ability in biofilm removal and re-colonization inhibition, respectively. Biofilm cell numbers and viability were assayed by colony-forming unit (CFU) count and metabolic-colorimetric (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) (XTT) assay. Results demonstrated that air-polishing performed with either sodium bicarbonate or erythritol/chlorhexidine was effective in reducing bacteria biofilm viability and number on pre-infected specimens, thus showing a similar ability in counteracting existing infection in situ; on the other hand, when air-polished pre-treated disks were infected, only erythritol/chlorhexidine powder showed higher post-treatment biofilm re-growth inhibition. Finally, surface analysis via mechanical profilometry failed to show an increase in titanium roughness, regardless of the powder selected, thus excluding any possible surface damage due to the use of either sodium bicarbonate or erythritol/chlorhexidine.
Article
Aim: To answer the PICOS question: in adult patients with peri-implantitis, what is the efficacy of sub-marginal instrumentation combined with chemical surface decontamination in comparison with sub-marginal instrumentation with or without placebo, in terms of changes in probing depth (PD) and/or bleeding on probing (BOP), as reported in prospective randomized controlled trials, nonrandomized controlled trials or prospective cohort studies, with a minimum of 6-month "follow-up". Materials and methods: A systematic literature search was performed in: PubMed, Web of Science (WOS), Embase, Scopus, Ovid Medline and The Cochrane Library of the Cochrane Collaboration (CENTRAL) for articles published until March 2022. Data addressing the primary and secondary outcomes were extracted. Results: The search gave 2033 results of which three studies fulfilled the inclusion criteria. Two studies investigated the use of antimicrobial photodynamic therapy as adjunct to submarginal instrumentation and the third study assessed the adjunctive use of a desiccant material. A meta-analysis was not deemed meaningful due to the large heterogeneity among studies. All three studies showed favourable results in terms of PD reduction for chemical surface decontamination over control approaches, but were inconsistent or showed no differences for the other outcome variables. Conclusions: Adjunctive chemical approaches for implant surface decontamination may offer an advantage over sub-marginal instrumentation alone, in terms of improved PD.
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Porphyromonas gingivalis (P. gingivalis) is a cornerstone pathogen in the development and progression of periodontal and peri-implant tissue destruction. It is capable of causing dysbiosis of the microbial biofilm and modulation of the host immune system. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan found in all living organisms. It is well known and has been used for improving tissue healing. In addition, some studies have suggested that there may be an antimicrobial potential to HA. The aim of this study was to evaluate the effect of hyaluronic acid, azithromycin (AZM), and chlorhexidine (CHX) on the expression of genes (i.e., fimA, mfa1, hagA, rgpA, rgpB, and kgp) related to the virulence and adhesion of P. gingivalis. The study groups were divided into four: (1) HA treated group; (2) AZM treated group; (3) CHX treated group; and (4) untreated group to serve as a negative control. P. gingivalis ATCC 33277 was cultured and then exposed to four different concentrations (100% MIC, 50% MIC, 25% MIC, and 12.5% MIC) of HA, AZM, and CHX for 24 h. The expression levels of the aforementioned genes were measured using quantitative reverse transcription polymerase chain reaction (RT-qPCR). Relative fold-change values were calculated and compared between groups. The fold-change values of all genes combined were 0.46 ± 0.33, 0.31 ± 0.24, and 0.84 ± 0.77 for HA, AZM, and CHX, respectively. HA has downregulated all the genes by mostly a half-fold: 0.35 ± 0.20, 0.47 ± 0.35, 0.44 ± 0.25, 0.67 ± 0.46, 0.48 ± 0.33 and 0.35 ± 0.22 with fimA, mfa1, hagA, rgpA, rgpB and kgp, respectively. The effect of HA was significant on all genes except rgpB compared to the untreated control. Lower concentrations of HA tended to exhibit greater downregulation with 1 mg/mL being the most effective. High molecular weight (1.5 MDa) hyaluronic acid has a potent effect on P. gingivalis by downregulating fimA, mfa1, hagA, rgpA, and kgp. The effect of HA was generally less than that of AZM but greater than that of CHX.
Article
Aim: The current in vitro model aims to evaluate the adjunctive effect on artificial biofilm removal determined by the use of a glycine-powder air-polishing procedure (GPAP) over the ultrasonic debridement (USD) alone when the removal of artificial biofilm on abutment surface is performed. The procedures were carried out also evaluating the impact of the site (mesial, distal, vestibular, and oral) and three different mucosal tunnel depths (2 mm, 4 mm, and 6 mm). Materials and methods: Single tooth implant replacement was simulated. Three different abutment heights together with a prosthetic contour were investigated (2 mm, 4 mm, and 6 mm); custom-made gingival masks were created to mimic peri-implant soft tissue. Biofilm was simulated with an indelible ink. The protocol consisted in two intervention stages for each abutment: (a) USD with PEEK tip plus (b) GPAP. At the end of each intervention, abutments were unscrewed, and standardized photographs were taken. Statistical analysis was carried out to compare residual stain percentage between the two intervention stages and among different sites and mucosal tunnels. Results: A total of 30 abutments were instrumented. A significant reduction of the percentage of residual staining (PRS) after the combination of GPAP + USD over USD alone was demonstrated (16% vs. 32%; p < 0.05). Moreover, the better performance of the GPAP + USD protocol was observed regardless of the different mucosal tunnel heights and the sites analyzed. Intragroup analysis unveils that the smaller PRS was observed for shallow mucosal tunnels (2 mm) and vestibular sites for both protocols. Conclusion: GPAP + USD provided adjunctive effect on artificial biofilm removal in comparison to the USD alone. Furthermore, proximal surfaces and deeper mucosal tunnels (4 and 6 mm) showed a reduced instrumentation efficacy for both protocols.
Article
Objective: To compare the clinical efficacy of combined application of glycine powder air-polishing and mechanical submucosal debridement in non-surgical treatment of peri-implant diseases. Methods: A randomized controlled clinical study was carried out on patients diagnosed with peri-implant diseases in the Department of Periodontology, Peking University School and Hospital of Stomatology, between May of 2020 and June of 2021.Twenty-eight patients with totally sixty-two implants were enrolled.The patients were randomly divided into the test group and control group. The patients in the test group (13 subjects/32 implants) received mechanical submucosal debridement using titanium curettes combined with application of glycine powder air-polishing, while the control group (15 subjects/30 implants) received mechanical submucosal debridement using titanium only. Clinical parameters, such as plaque index (PLI), pocket probing depth (PPD), bleeding index (BI) and the percentage of suppuration on probing on implants' level (SoP%) were measured at baseline and 8 weeks after non-surgical intervention. Changes and group differences of clinical parameters of the implants before and 8 weeks after non-surgical intervention were compared. Results: Mean PLI, PPD, BI of both the test group and control group significantly reduced 8 weeks after non-surgical intervention (P < 0.05). Compared with the control group, the test group achieved lower BI (2.7±0.8 vs. 2.2±0.7, P < 0.05), more reduction of BI (0.6±0.7 vs. 1.1±0.6, P < 0.01) and more reduction of SoP% (21.9% vs. 10%, P < 0.05) after non-surgical intervention. Both the control and test groups exhibited comparable PLI and PPD reductions (P>0.05). For the implants diagnosed with peri-implant mucositis, the test group revealed more signi-ficant reduction in BI and SoP% than the control group (1.0±0.7 vs. 0.4±0.7, P=0.02; 6.3% vs. 0, P=0.012). There was no significant difference existing in PLI and PD improvement between the control group and test group (P>0.05). For the implants diagnosed with peri-implantitis, there was no significant difference existing in PLI, PPD, BI and SoP% improvement values between the test and control groups (P>0.05). No complications or discomforts were reported during the study. Conclusion: Both treatment procedures could relieve the inflammation of peri-implant soft tissue. Non-surgical mechanical submucosal debridement combined application of glycine powder air-polishing is associated with significant reduction of soft tissue bleeding and suppuration on probing especially in the implants diagnosed with peri-implant mucositis.
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Professional oral hygiene is fundamental to prevent peri-implant disease. Appropriate instruments should be used in patients with restorations supported by dental implants: they should be effective in deposits removal without damaging the implant components surface. The aim of the present study is to investigate and summarize the results regarding the efficacy of oral hygiene techniques described in the literature in the last 10 years in patients rehabilitated with dental implants not affected by perimplantitis. The present systematic review was conducted according to guidelines reported in the indications of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The focused question was: “Which are the most effective instruments for professional oral hygiene on implants not affected by perimplantitis?”. The initial database search yielded a total of 934 entries found in PubMed®/MEDLINE and Cochrane Library. After full text review and application of the eligibility criteria, the final selection consisted of 19 articles. The risk of bias of included studies was assessed using the Newcastle Ottawa scale (NOS) and the Cochrane Handbook for Systematic Reviews of Interventions. Curette, scalers and air polishing were the devices most frequently investigated in the included studies. In particular, glycine powder air polishing appeared to be significantly effective in reducing peri-implant inflammation and plaque around implants. The application of the more recent erythritol powder air polishing also yielded good clinical outcomes. Further studies are needed to improve the knowledge on the topic in order to develop standardized protocols and understand the specific indications for different types of implant-supported rehabilitations.
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Background/purpose Although several mechanical and chemical debridement techniques have been reported for the management of peri-implantitis, there is no consensus on the most effective method at present. This in vitro study aimed to examine the effects of different mechanical instrumentation techniques on the debridement of hard calcified materials, which are present on the implant surface, as well as the effect of the defect morphology. Materials and methods From a total of 15 implants, five each were assigned to one of three decontamination groups (Rotary titanium brush [Ti], tricalcium phosphate air powder abrasive treatment [Air], and titanium ultrasonic scaler [US] groups); the exposed hydroxyapatite (HA)-coated portion was divided into three 1-mm sections (coronal, middle, and apical). The residual-HA of each portion was measured using a digital microscope. Results The overall percentage of residual HA coating was significantly lower in the US group than in the Ti or Air groups (p < 0.01). The percentage of residual HA in the coronal portion was significantly lower in the Ti and US groups than in the Air group (p < 0.05 and p < 0.01, respectively). The percentage of residual HA in the middle portion was significantly lower in the US group than in the Air group (p < 0.01). The percentage of residual HA in the apical portion was significantly lower in the Ti group than in the Air or US groups (p < 0.01). Conclusion Ti and US were more effective for shallow defects, whereas US was more effective for deeper defects.
Chapter
Dental implants have transformed the treatment of partially and completely edentulous patients. Despite their success, dental implants have the potential for biological and mechanical complications. This chapter focuses on the biological aspect of peri-implant disease in both soft and hard tissues. A review of the types of peri-implant diseases, including mucositis, peri-implantitis, and retrograde peri-implantitis, is presented. Their possible etiologies and predisposing factors are reviewed. Also, non-surgical therapeutic clinical treatment modalities, including cleaning and scaling, antiseptics, and the use of antibiotics locally and systemically, are discussed. Surgical resection and regenerative treatment modalities for advanced disease are presented based on the literature’s most recent evidence.
Article
Objective Assessment of a dental student's clinical performance is essential for providing feedback for improving education. This study evaluated the ability of undergraduate dental students to treat periodontal patients with two techniques, ultrasonic debridement with polishing (UD+P) and the erythritol powder air-polishing with ultrasonic instrumentation (EPAP+UD) in a split-mouth design. Methods The study was conducted on undergraduate students with patients suffering from gingivitis and stage I periodontitis with grade A. The evaluation consisted of two parts. First, assessment of the student by clinical indices (full mouth plaque index (FMPI), calculus index (CI), remaining calculus index (RCI), modified gingival index (MGI) and papillary bleeding index (PBI)) at baseline, immediately and after 2-weeks. In addition to assessing treatment time for each student. Secondly, obtaining student feedback about the two methods used. Results Five undergraduate fourth years’ students and thirteen patients participated. Statistically significant decreases in FMPI, CI, MGI and PBI between baseline and 2-weeks post-treatment were noted in both test and control groups. Inter-group comparisons, at 2-weeks, there was a statistically significant difference in FMPI and MGI indices and immediately after treatment, there was also a significant reduction in FMPI and CI. Treatment-time was significantly less for the EPAP+UD method and it got 10-time method preferring in comparison to the control group (UD+P) by students. Conclusion The undergraduate dental student has the capacity to treat the periodontal patient using both approaches with a preference for the EPAP+ UI approach over UI+P. In addition, this EPAP+ UI is a promising method of education.
Article
Introduction To simulate removing luting agent remnants from crowns fixed onto implant-abutment analogs using a standardized machine-driven protocol including a scaler and air polishing or sonic. Material and methods A motor-driven device was constructed that controlled the rotational speed of the specimens, machining distance, contact pressure, and working time. A standardized layer of cement (Provicol, VOCO; Cuxhaven, G; Ketac Cem, 3MEspe; Seefeld, G; or Rely X Unicem, 3MEspe, Seefeld, G) was placed onto the finishing line of the crowns luted onto titanium-abutment analogs. The cement layer was scaled with a fresh titanium scaler maneuvered by the motor-driven device and treated with air polishing or sonic. Protocol 1: Scaling only for 20s, 40s, or 60s; n=20; protocol 2: 40s of scaling plus 20s of air polishing; protocol 3: 20s of scaling plus 40s of air polishing; protocol 4: 20s of scaling plus 40s of sonic; protocol 5: 40s of scaling plus 20s of sonic; protocols 2–5: n=10. Cement remnants were counted digitally as “percentage of remnants”. Statistics: mean, standard deviation, Bonferroni post hoc tests; α=0.05. Results Ketac Cem was easily removed by scaling only and Provicol by scaling and air polishing, but the self-adhesive resin composite cement Rely X Unicem was not removable with the device. Only remnants of Provicol could be significantly reduced by further treatment after scaling (p<0.001). Conclusion The presented motor-driven device enables reproducible investigations of various cleaning protocols and is thus useful to create an overview of cleaning protocols needed for the different types of cement.
Article
Background: Peri-implantitis treatment is a very challenging topic to discuss. What is certain is that preventive/supportive therapy plays a key-role in peri-implant tissues' health maintenance and non-surgical implant surface mechanical debridement remains one of the solid pillars in the therapeutic pathway. In this perspective, many surface decontaminating methods have been proposed and tested to remove hard and soft bacterial deposits. The aim of this study was to compare four different commonly used non-surgical implant debridement methods in terms of cleaning potential in vitro, using a peri-implant pocket-simulating model. Methods: Sixty-four dental implants were ink-stained and placed into a simulated peri-implant pocket. Samples were then divided into four groups and treated with different debridement methods: stainless-steel ultrasonic tip (PS), peek-coated ultrasonic tip (PI), sub-gingival air-polishing with erythritol powder (EHX) and sub-gingival air-polishing with glycine powder (GLY). For each treatment group, half of the samples were treated for 5 seconds and the other half for 45 seconds. High-resolution images were taken using a digital microscope and later analyzed with a light processing software for measuring the cleaned area percentage (ink-free). Two different images were captured for every sample: a first image with the implant positioned perpendicular to the microscope lenses (90°) and a second one with the implant placed with a 45° vertical angulation, with the smooth neck towards the ground. Percentage of removed ink was statistically modelled using a generalized linear mixed model with the implant as a random (clustering) factor. Results: A paired comparison between all treatments in terms of debridement potential (cleaned area percentage) was performed. In 5s and with 90° sample angulation EHX/PS comparison showed an odds ratio of 2.75 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 2.90 (P<0.001), PI/GLY an OR of 0.19 (P<0.001) and PI/PS an OR of 0.56 (P=0.105). With the same sample angulation and 45s treatment time, the OR was 6.97 (P<0.001) for EHX/PS comparison, 0.14 (P<0.001) for PI/EHX comparison, 4.99 (P<0.001) for GLY/PS, 0.19 (P<0.001) for PI/GLY and 0.95 for PI/PS (P =0.989). With 5s of treatment time and 45° sample angulation, EHX/PS comparison shows a 3.19 odds ratio (P<0.001), PI/EHX a 0.14 odds ratio (P<0.001), GLY/PS a 3.06 odds ratio (P<0.001), PI/GLY a 0.15 odds ratio (P<0.001) and PI/PS a 0.46 odds ratio (P=0.017). With the same sample angulation but 45s treatment time, EHX/PS comparison produced an odds ratio of 4.90 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 8.74 (P<0.001), PI/GLY an OR of 0.11 (P<0.001) and PI/PS an OR 0.96 of (P =0.996). Conclusions: Among the four treatments considered, air-polishing therapy represents the best one in terms of ink removal from the implant surface. Furthermore, increasing the treatment time to 45 seconds, air-polishing resulted considerably more efficient.
Article
Context: Low-abrasive polishing powders such as glycine (GLY) or erythritol (ERY) are used for subgingival air polishing. GLY was reported to possibly affect the dentin surface, while this is unclear for ERY. Aims: This in vitro study aimed to evaluate the substance loss from the dentin surface by air polishing with ERY at different settings for pressure (PR), distance (DI), and angulation of the spray jet to the surface (AJ). Materials and methods: The in vitro testing was performed on smooth human root dentin surfaces. In 18 groups with 10 specimens each, ERY was applied with constant water supply for 5 s without moving the handpiece at the following settings: PR minimum (min), medium (med), and maximum (max); DI at 1, 3, and 5 mm; and 45° or 90° AJ. The substance loss was measured as defect depth (DD) using three-dimensional (3D)-laser profilometry. ANOVA with Bonferroni correction and α = 0.05 were used for statistical analysis. Results: The DD was statistically significantly higher at a DI of 1 mm compared to a DI of 5 mm for the respective groups of the same PR and AJ (P < 0.05). For DI 1 mm, max PR, and AJ 90°, the maximum loss of substance amounted DD of 117 ± 43 μm. The minimal loss of substance occurred at minimal PR, 45° AJ, and a DI of 5 mm (15 μm × 20 μm). DD related directly with the parameters PR and AJ and inversely with DI. The highest influence on DD was proven for DI. Conclusions: Slight loss of dentin might occur during air polishing with ERY depending on DI, PR and AJ. The setting influences the amount of dentin loss.
Chapter
Implant-related pathologic bone loss is the most common problem but not limited only to infectious diseases. Before focusing on peri-implant disease treatment; predisposing local factors, such as cement remnants, bruxism, and systemic factors must be evaluated and eliminated before local treatment attempt. Peri-implant infections are reversible while limited in gingival tissue level. However, irreversible and progressive when infiltrates to connective and bone tissue. The treatment of peri-implant infections must cover the removal of gross debris (debridement), and eradication of biofilm from the implant surface to achieve bone regeneration. The bone regeneration following those steps can be achieved with bone grafting or guided bone regeneration techniques. Mobility of the implant indicates the removal of the implant. A biopsy must be obtained from those peri-implant diseases, which do not respond to any of these treatment modalities or have an unusual clinical appearance.
Article
Die nichtchirurgische (antiinfektiöse) Therapie der Parodontitis stellt eine zentrale und entscheidende Phase in der systematischen Parodontalbehandlung dar. Unter dem Einfluss neuer klinischer Studien haben sich die Therapieansätze zur Wurzeloberflächenbearbeitung in den letzten Jahren weiterentwickelt. Insbesondere minimalinvasive Methoden zur Biofilmentfernung haben sich zunehmend etabliert. Das wichtigste Ziel ist die Reduktion der parodontalen Entzündung. Hierfür bleibt die mechanische Instrumentierung bzw. Reinigung der Wurzeloberfläche die Grundlage. Der folgende Beitrag erläutert die Bedeutung sowie die konzeptionelle Einordnung der mechanischen Wurzeloberflächenbearbeitung und bietet einen Überblick über die dazu geeigneten Geräte und Materialien zur kausalen und unterstützenden Parodontitistherapie. Indikationen, Handhabungen sowie Vor- und Nachteile von Handinstrumenten, Ultraschall- bzw. Schallinstrumenten sowie Pulver-Wasserstrahl-Geräten werden vorgestellt und diskutiert.
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Peri-implant diseases are a common problem in dentistry today and no definitive treatment protocol exists for their treatment. The purpose of this review was to examine the evidence concerning the management of these diseases. The evidence provided suggests that peri-mucositis can be managed with use of mechanical nonsurgical therapy. Peri-implantitis does not respond to nonsurgical therapy. Various surgical methods have been proposed for management of peri-implantitis with some success; however, no single method can be promoted based on the current evidence.
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Article
The use of appropriate instruments to clean surfaces with minimal change, is critical for the successful maintenance of a dental implant. However, there is no consensus about the type and methodology for such instruments. The aim of this study was to characterize changes in the roughness of titanium surfaces treated by various scaling instruments. Thirty-seven identical disks (5 mm in diameter) were investigated in this study. The specimens were divided into eight groups according to the types of instrumentation and the angle of application. Ultrasonic scaling systems were applied on a titanium disk to simulate standard clinical conditions. The equipment included a piezoelectric ultrasonic scaler with a newly developed metallic tip (NS group), a piezoelectric ultrasonic scaler with a conventional tip (CS group), a piezoelectric root planer ultrasonic scaler with a conventional tip (PR group), and a plastic hand curette (PH group). In addition, the sites treated using piezoelectric ultrasonic scaler systems were divided two sub-groups: 15 and 45 degrees. The treated titanium surfaces were observed by scanning electron microscopy (SEM), and the average surface roughness (Ra) and mean roughness profile depth (Rz) were measured with a profilometer. SEM no significant changes in the titanium surfaces in the NS group, regardless of the angle of application. The PH group also showed no marked changes to the titanium surface, although some smoothening was observed. All CS and PR sites lost their original texture and showed irregular surfaces in SEM analysis. The profilometer analysis demonstrated that the roughness values (Ra and Rz) of the titanium surfaces increased in all, except the PH and NS groups, which showed roughness decreases relative to the untreated control group. The Ra value differed significantly between the NS and PR groups (P<0.05). The results of this study indicated that changes in or damage to titanium surfaces might be more affected by the hardness of the scaler tip than by the application method. Within the limitations of this study, the newly developed metallic scaler tip might be especially suitable for peri-implant surface decontamination, due to its limited effects on the titanium surface.
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Background: One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (peri-implantitis) and ultimately to implant failure. Different treatment strategies for peri-implantitis have been suggested, however it is unclear which are the most effective. Objectives: To identify the most effective interventions for treating peri-implantitis around osseointegrated dental implants. Search methods: We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 9 June 2011. Selection criteria: All RCTs comparing agents or interventions for treating peri-implantitis around dental implants. Data collection and analysis: 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. We contacted the authors for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Main results: 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); different surgical interventions (two trials); 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% confidence interval (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 peri-implant infrabony defects > 3 mm treated with Bio-Oss and resorbable barriers gained 1.4 mm more PAL (95% CI 0.24 to 2.56) and 1.4 mm PPD (95% CI 0.81 to 1.99) than patients treated with a nanocrystalline hydroxyapatite. Authors' conclusions: 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 the use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for 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-up longer than 1 year are needed.
Article
Purpose: To evaluate the success of treatments aimed at the resolution of peri-implantitis in patients with osseointegrated implants. Materials and methods: The potentially relevant literature was assessed independently by two reviewers to identify case series and comparative studies describing the treatment of peri-implantitis with a follow-up of at least 3 months. Medline, Embase, and The Cochrane Library were searched. For the purposes of this review, a composite criterion for successful treatment outcome was used which comprised implant survival with mean probing depth < 5 mm and no further bone loss. Results: A total of 43 publications were included: 4 papers describing 3 nonsurgical case series, 13 papers describing 10 comparative studies of nonsurgical interventions, 15 papers describing 14 surgical case series, and 11 papers describing 6 comparative studies of surgical interventions. No trials comparing nonsurgical with surgical interventions were found. The length of follow-up varied from 3 months to 7.5 years. Due to the heterogeneity of study designs, peri-implantitis case definitions, outcome variables, and reporting, no meta-analysis was performed. Eleven studies could be evaluated according to a composite success criterion. Successful treatment outcomes at 12 months were reported in 0% to 100% of patients treated in 9 studies and in 75% to 93% of implants treated in 2 studies. Commonalities in treatment approaches between studies included (1) a pretreatment phase, (2) cause-related therapy, and (3) a maintenance care phase. Conclusions: While the available evidence does not allow any specific recommendations for the therapy of peri-implantitis, successful treatment outcomes at 12 months were reported in a majority of patients in 7 studies. Although favorable short-term outcomes were reported in many studies, lack of disease resolution as well as progression or recurrence of disease and implant loss despite treatment were also reported. The reported outcomes must be viewed in the context of the varied peri-implantitis case definitions and severity of disease included as well as the heterogeneity in study design, length of follow-up, and exclusion/inclusion criteria.
Article
Objective The objective of this systematic review was to evaluate the effect of mechanical instruments on the biocompatibility of titanium dental implant surfaces.Materials and methodsMEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to December 2013, to identify controlled studies on the ability of cells to adhere and colonize non-contaminated and contaminated, smooth and rough, titanium surfaces after instrumentation with different mechanical instruments.ResultsA comprehensive search identified 1893 unique potential papers. Eleven studies met the inclusion criteria and were selected for this review. All studies were in vitro studies. Most studies used titanium discs, strips and cylinders. The air abrasive was the treatment mostly evaluated. The available studies had a high heterogeneity which precluded any statistical analysis of the data. Therefore, the conclusions are not based on quantitative data. Instrumentation seems to have a selective influence on the attachment of different cells. In the presence of contamination, plastic curettes, metal curettes, rotating titanium brushes and an ultrasonic scaling system with a carbon tip and polishing fluid seem to fail to restore the biocompatibility of rough titanium surfaces. The air-powder abrasive system with sodium bicarbonate powder does not seem to affect the fibroblast–titanium surface interaction after treatment of smooth or rough surfaces, even in the presence of contamination.Conclusion The available data suggest that treatment with an air-powder abrasive system with sodium bicarbonate powder does not seem to adversely affect the biocompatibility of titanium dental implant surfaces. However, the clinical impact of these findings requires further clarification.
Article
To assess the cleaning potential of three different instrumentation methods commonly used for implant surface decontamination in vitro, using a bone defect-simulating model. Dental implants were stained with indelible ink and mounted in resin models, which represented standardized peri-implantitis defects with different bone defect angulations (30, 60 and 90°). Cleaning procedures were performed by either an experienced dental hygienist or a 2nd-year postgraduate student. The treatment was repeated 20 times for each instrumentation, that is, with a Gracey curette, an ultrasonic device and an air powder abrasive device (PAD) with glycine powder. After each run, implants were removed and images were taken to detect color remnants in order to measure planimetrically the cumulative uncleaned surface area. SEM images were taken to assess micromorphologic surface changes (magnification 10,000×). Results were tested for statistical differences using two-way ANOVA and Bonferroni correction. The areas of uncleaned surfaces (%, mean ± standard deviations) for curettes, ultrasonic tips, and airflow accounted for 24.1 ± 4.8%, 18.5 ± 3.8%, and 11.3 ± 5.4%, respectively. These results were statistically significantly different (P < 0.0001). The cleaning potential of the airflow device increased with wider defects. SEM evaluation displayed distinct surface alterations after instrumentation with steel tips, whereas glycine powder instrumentation had only a minute effect on the surface topography. Within the limitations of the present in vitro model, airflow devices using glycine powders seem to constitute an efficient therapeutic option for the debridement of implants in peri-implantitis defects. Still, some uncleaned areas remained. In wide defects, differences between instruments are more accentuated.
Article
To review the literature on the prevalence and incidence of peri-implantitis. Out of 322 potentially relevant publications we identified 29 articles concerning 23 studies, with information on the presence of signs of peri-implantitis in populations of at least 20 cases. All studies provided data from convenience samples, typically from patients who were treated in a clinical center during a certain period, and most data were cross-sectional or collected retrospectively. Based on the reviewed papers one may state that the prevalence of peri-implantitis seems to be in the order of 10% implants and 20% patients during 5-10 years after implant placement but the individual reported figures are rather variable, not easily comparable and not suitable for meta-analysis. Factors that should be considered to affect prevalence figures are the disease definition, the differential diagnosis, the chosen thresholds for probing depths and bone loss, differences in treatment methods and aftercare of patients, and dissimilarities in the composition of study populations. Smoking and a history of periodontitis have been associated with a higher prevalence of peri-implantitis.
Article
The objective of this systematic review was to assess the 5- and 10-year survival of implant-supported fixed dental prostheses (FDPs) and to describe the incidence of biological and technical complications. An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on FDPs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year and 10-year survival and complication rates. The updated search provided 979 titles and 257 abstracts. Full-text analysis was performed for 90 articles resulting in a total 32 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants supporting FDPs of 95.6% after 5 years and 93.1% after 10 years. When machined surface implants were excluded from the analysis and only rough surface implants included, the survival rate increased to 97.2% after 5 years. The survival rate of implant-supported FDPs was 95.4% after 5 years and 80.1% after 10 years of function. When the analysis was done exclusively for metal-ceramic FDPs, hence the old gold-acrylic FDPs were excluded, the survival rate increased significantly. The survival rate of metal-ceramic implant-supported FDPs was 96.4% after 5 years and 93.9% after 10 years. Only 66.4% of the patients were free of any complications after 5 years. The most frequent complications over the 5-year observation period were fractures of the veneering material (13.5%), peri-implantitis and soft tissue complications (8.5%), loss of access hole restoration (5.4%), abutment or screw loosening (5.3%), and loss of retention of cemented FDPs (4.7%). It may be concluded that implant-supported fixed dental prostheses (FDPs) are a safe and predictable treatment method with high survival rates. However, biological and technical complications were frequent (33.6%). To minimize the incidence of complications, dental professionals should make great effort in choosing reliable components and materials for implant-supported FDPs and the patients should be placed in well-structured maintenance system after treatment.
Article
To assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological, technical, and aesthetic complications. The focused question was: What is the survival rate of implants supporting single crowns and implant-supported crowns with a mean follow-up of 5 years and to which extent do biological, technical, and aesthetic complications occur? A Medline search (2006-2011) was performed for clinical studies focusing on implant-supported SCs with a mean follow-up of at least 5 years. The search was complemented by an additional hand search and the inclusion of 24 studies from a previous systematic review (Jung et al. 2008a). Survival and complication rates were analyzed using random-effects Poisson's regression models to obtain summary estimates of 5- and 10-year proportions. Forty-six studies derived from an initial search count of 1083 titles and the complementary publications from the previous systematic review (Jung et al. 2008a) were selected and the data were extracted. Based on the meta-analysis, survival of implants supporting SCs at 5 years amounted to 97.2% (95% CI: 96.3-97.9%), and at 10 years amounted to 95.2% (95% CI: 91.8-97.2%). The survival of implant-supported SCs was 96.3% (95% CI: 94.2-97.6%) after 5 years and 89.4% (95% CI: 82.8-93.6%) after 10 years. For biological complications, a 5-year cumulative soft tissue complication rate of 7.1% (95% CI: 4.4-11.3%) and a cumulative complication rate for implants with bone loss >2 mm of 5.2% (95% CI: 3.1-8.6%) were calculated. Technical complications reached a cumulative incidence of 8.8% (95% CI: 5.1-15.0%) for screw-loosening, 4.1% (95% CI: 2.2-7.5%) for loss of retention, and 3.5% (95% CI: 2.4-5.2%) for fracture of the veneering material after 5 years. The cumulative 5-year aesthetic complication rate amounted to 7.1% (95% CI: 3.6-13.6%). The outcomes of the meta-analysis demonstrated high implant survival rates for both the single tooth implants and the respective single crowns after 5 and 10 years. However, technical, biological, and aesthetic complications were frequent.
Article
OBJECTIVES: The study aimed to assess the accessibility of a glycine powder blasting device to implant surfaces in models imitating different peri-implantitis defects. The null hypothesis was that the device allows for complete surface decontamination in all defect types. MATERIALS AND METHODS: Eighteen implants were dip-coated and placed in resin blocks with different defect morphologies. Vertical bone angulations of 90°, 60°, 30° and 15° were chosen and the implants were treated for 10 s using an air-flow device employing glycine powder. Once removed, photographs from the implants were taken in three directions: perpendicularly (90°) to the implant axis and with an angulation of 60° and 120°, the latter ones to assess the coronal and apical thread areas. The area with residual color represented areas, which were not accessible to the powder. This area was planimetrically assessed. Medians and inter-quartile ranges (IQR) of the percentage of uncleaned surfaces were calculated and nonparametric paired and unpaired statistical analyses were performed. RESULTS: The median percentages (IQR in brackets) of uncleaned areas in the 90°, 60°, 30° and 15° defects were of 3%(A) (6), 8%(A) (4), 24%(B) (8), and 51%(C) (13), respectively (different superscript capital letters represent statistically significant differences; P < 0.0001). The upper aspects of the threads (coronal faces) were significantly better cleaned than the lower ones (P < 0.001). This finding was more pronounced in narrower defects. CONCLUSION: Although a complete surface decontamination could not be performed in any of the defects, the biggest part of the surface could be cleaned in the larger defects. Especially in narrow defects and under the threads, residually stained areas remain on the implant surfaces.
Article
To systematically collect and evaluate existing evidence on the effects of different mechanical instruments on the surface characteristics of smooth and rough titanium surfaces. PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to December 2010 to identify appropriate studies. The eligible studies were controlled studies investigating titanium surface alterations following treatment with different mechanical instruments. In total, 3275 unique papers were identified. A screening of the titles and abstracts resulted in 34 publications that met all of the eligibility criteria. Surface roughness was evaluated using scanning electron microscopy in most studies and using a profilometer in only 10 studies. The rough surfaces evaluated were titanium plasma sprayed and sandblasted and acid-etched surfaces only. Non-metal instruments were found to cause minimal or no damage to both smooth and rough titanium surfaces. Metal instruments were found to cause major damage to smooth surfaces. Burs seemed to be the instruments of choice, if smoothening of a rough surface was required. Non-metal instruments and rubber cups seem to be the instruments of choice for the treatment of smooth surfaces. Similarly, for rough implant surfaces, non-metal instruments and air abrasives are the instruments of choice, if surface integrity needs to be maintained. Metal instruments and burs are recommended only in cases requiring the smoothening of the surface roughness. The clinical impact of these findings requires clarification.
Article
To assess the effectiveness of different chemotherapeutic agents on biofilm-contaminated titanium surfaces. This study used a recently described biofilm model. In experiment 1, Streptococcus mutans biofilms grown on titanium discs were treated with (1) EDTA, (2) citric acid (CA), (3) cetylpyridium chloride, (4) Ardox-X, (5) hydrogen peroxide (H(2) O(2) ), (6) chlorhexidine (CHX) and (7) water. In experiment 2, polymicrobial biofilms were treated with (1) CA, (2) Ardox-X, (3) H(2) O(2) , (4) Ardox-X followed by CA, (5) H(2) O(2) followed by CA, (6) CHX and (7) water. Aliquots of the suspended biofilms were plated and incubated anaerobically to enable counts of the total remaining viable bacteria, which were expressed as CFUs. Following incubation, the amount of protein remaining in the treated S. mutans biofilms was quantified to assess the removal potency of each treatment agent. H(2) O(2) , Ardox-X and CA killed significantly more S. mutans compared with the other treatments. H(2) O(2) and CA removed significantly more protein than water. CA and the combination treatments were significantly more effective against the polymicrobial biofilms than CHX, H(2) O(2) and Ardox-X. The difference in the killing efficacy between CA alone and the combination treatments was not statistically significant. Among the chemicals tested, CA demonstrated the greatest decontamination capacity with respect to both the killing and the removal of biofilm cells. This combination of effects is clinically desirable because it promotes biocompatibility and healing around a previously contaminated implant surface. These results should, however, be validated in in vivo studies.
Article
Background: One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction (perimplantitis) and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective. Objectives: To identify the most effective interventions for treating perimplantitis around osseointegrated dental implants. Search strategy: We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE. Handsearching included several dental journals. We checked the bibliographies of the identified randomised controlled trials (RCTs) and relevant review articles for studies outside the handsearched journals. We wrote to authors of all identified RCTs, to more than 55 dental implant manufacturers and an Internet discussion group to find unpublished or ongoing RCTs. No language restrictions were applied. The last electronic search was conducted on 7th January 2010. Selection criteria: All RCTs comparing agents or interventions for treating perimplantitis around dental implants. Data collection and analysis: 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. We contacted the authors for missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was to be investigated including both clinical and methodological factors. Main results: Twelve eligible trials were identified, but five were excluded. The following procedures were tested: (1) use of local antibiotics versus ultrasonic debridement; (2) benefits of adjunctive local antibiotics to debridement; (3) different techniques of subgingival debridement; (4) laser versus manual debridement and chlorhexidine irrigation/gel; (5) systemic antibiotics plus resective surgery plus two different local antibiotics with and without implant surface smoothening; and (6) nanocrystalline hydroxyapatite versus Bio-Oss and resorbable barriers. Follow-up ranged from 3 months to 4 years. The only statistically significant differences were observed in two trials judged to be at 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 and reduced probing pockets depths (PPD) of 0.59 mm. After 4 years, patients with perimplant infrabony defects > 3 mm treated with Bio-Oss and resorbable barriers gained 1.4 mm more PAL and PPD than patients treated with a nanocrystalline hydroxyapatite. Authors' conclusions: There is very little reliable evidence suggesting which could be the most effective interventions for treating perimplantitis. This is not to say that currently used interventions are not effective. The use of local antibiotics in addition to manual subgingival debridement was associated with a 0.6 mm additional improvement for PAL and PPD over a 4-month period in patients affected by severe forms of perimplantitis. 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 perimplant infrabony defects. In four trials, the control therapy which basically consisted of a simple subgingival mechanical debridement seemed to be sufficient to achieve similar results to the more complex and expensive therapies. Follow-up longer than 1 year suggested recurrence of perimplantitis up to 100% of the treated cases for some of the tested interventions. Sample sizes were very small and follow-up too short, therefore these findings have to be considered with great caution. Larger well-designed RCTs with follow-up longer than 1 year are needed.
Article
This review was undertaken to address the similarities and dissimilarities between the two disease entities of periodontitis and peri-implantitis. The overall analysis of the literature on the etiology and pathogenesis of periodontitis and peri-implantitis provided an impression that these two diseases have more similarities than differences. First, the initiation of the two diseases is dependent on the presence of a biofilm containing pathogens. While the microbiota associated with periodontitis is rich in gram-negative bacteria, a similar composition has been identified in peri-implant diseases. However, increasing evidence suggests that S. aureus may be an important pathogen in the initiation of some cases of peri-implantitis. Further research into the role of this gram-positive facultative coccus, and other putative pathogens, in the development of peri-implantitis is indicated. While the initial host response to the bacterial challenge in peri-implant mucositis appears to be identical to that encountered in gingivitis, persistent biofilm accumulation may elicit a more pronounced inflammatory response in peri-implant mucosal tissues than in the dentogingival unit. This may be a result of structural differences (such as vascularity and fibroblast-to-collagen ratios). When periodontitis and peri-implantitis were produced experimentally by applying plaque-retaining ligatures, the progression of mucositis to peri-implantitis followed a very similar sequence of events as the development of gingivitis to periodontitis. However, some of the peri-implantitis lesions appeared to have periods of rapid progression, in which the infective lesion reached the alveolar bone marrow. It is therefore reasonable to assume that peri-implantitis in humans may also display periods of accelerated destruction that are more pronounced than that observed in cases of chronic periodontitis. From a clinical point of view the identified and confirmed risk factors for periodontitis may be considered as identical to those for peri-implantitis. In addition, patients susceptible to periodontitis appear to be more susceptible to peri-implantitis than patients without a history of periodontitis. As both periodontitis and peri-implantitis are opportunistic infections, their therapy must be antiinfective in nature. The same clinical principles apply to debridement of the lesions and the maintenance of an infection-free oral cavity. However, in daily practice, such principles may occasionally be difficult to apply in peri-implantitis treatment. Owing to implant surface characteristics and limited access to the microbial habitats, surgical access may be required more frequently, and at an earlier stage, in periimplantitis treatment than in periodontal therapy. In conclusion, it is evident that periodontitis and peri-implantitis are not fundamentally different from the perspectives of etiology, pathogenesis, risk assessment, diagnosis and therapy. Nevertheless, some difference in the host response to these two infections may explain the occasional rapid progression of peri-implantitis lesions. Consequently, a diagnosed peri-implantitis should be treated without delay.
Article
This systematic review aimed to assess the available literature for regenerative treatment of peri-implantitis using bone graft substitutes and membranes. A search in electronic databases was conducted to assess all types of clinical studies treating bone defects derived from peri-implantitis using guided bone regeneration (GBR) techniques. During the first screening, 399 titles were identified. Finally, 17 articles reporting on 173 implants were included. The articles mainly focused on radiographic bone fill of the defect. Qualitative measures of "bone fill" were reported: 10.4% of the implants showed complete "bone fill," whereas 85.5% revealed incomplete defect closure. No bone fill was shown in 4.0%. Little information (in 53.2%) was provided regarding the probing depth before or after treatment. Data concerning the inflammatory status of soft tissues were also scarce and only reported in three studies. A large heterogeneity concerning disinfection protocols and regenerative materials used was found. The high percentage of low-quality studies rendered a meta-analysis impossible. Complete fill of the bony defect using GBR seems not to be a predictable outcome. The mucosal health status is left unconsidered in most studies. Well-controlled trials are needed to determine predictable treatment protocols for the successful regenerative treatment of peri-implantitis using GBR technique.