Article

A new multiple anti-infective non-surgical therapy in the treatment of peri-implantitis: A case series

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Abstract

Background: Peri-implantitis is a frequent disease that may lead to implant loss. The aim of this case series was to evaluate the clinical results of a new non-surgical treatment protocol. Methods: Fifteen patients with dental implants affected by peri-implantitis were treated with a multiple anti-infective non-surgical treatment (MAINST) which included two steps: 1) supra-gingival decontamination of the lesion and sub-gingival treatment with a controlled-release topical doxycycline; 2) after one week, a session of supra and sub gingival air polishing with Erythritol powder and ultrasonic debridement (where calculus was present) of the whole oral cavity was performed along with a second application of topical doxycycline around the infected implant. Primary outcome measures were: implant failure; complications and adverse events; recurrence of peri-implantitis; secondary outcome measure were presence of Plaque (PI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD). Recession (REC), Relative Attachment level (RAL). Results: Neither implant failure nor complications nor adverse events were reported. Statistically (p < 0.01) and clinically significant reductions between baseline and 1 year of PI (100% vs 13.9%, CI95% 72.4%; 93.7%); BOP (98.5% vs 4.5%, CI95% 85.4%; 98.5%) and PPD (7.89mm vs 3.16mm CI95% -5.67; -3.77), were detected. At baseline, all 15 patients had a PPD > 5 mm at the affected implant(s), whereas only 3.7% at 3 month follow-up a PPD> 5 mm, and none at 6 and 12 months. Conclusions: Within the limits of this study, the MAINST protocol showed improvement of clinical parameters for the treatment of peri-implantitis, which were maintained for up to 12 months.

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... Various treatments involving non-surgical or surgical debridement and decontamination followed by ongoing supportive therapy [8][9], or regeneration of the peri-implant bone defect [9][10], application of antibiotics such as tetracycline to the implant surface [11][12], have been described in the available literature. However, the most effective protocol for implant surface decontamination and appropriate choice of regenerative materials is still unclear in the literature [13]. ...
... Initial therapy involved scaling and root planning using ultrasonic and hand scalers for the natural dentition and use of titanium hand curettes for implant #18 followed by oral hygiene instructions. as reported in the literature [11][12]. The block was then shaped to conform to the defect shape, and the site was grafted with the block to fill the defect completely and the graft was covered with a native bilayer resorbable collagen membrane (Figure 7). ...
... A periapical radiograph was taken at 6 months and it showed bone-fill in the grafted defect (Figure 20a shown to leave drug residues which might interfere with re-osseointegration and act as a reservoir of microorganisms [22]. In the GIT technique, the DBBM-C is soaked in an appropriate antibiotic (either sensitivity-specific antibiotic based on culture, or tetracycline [11][12], where culture is not possible). This may assist in providing localized antibiotic delivery, while using an osteoconductive carrier for future regeneration. ...
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Article
Peri-implantitis is a site-specific infectious disease that causes an inflammatory process in soft tissues, and bone loss around an osseointegrated implant in function. Several techniques with non‐surgical or surgical debridement and decontamination followed by ongoing supportive therapy or regeneration of the peri‐implant bone defects have been proposed in the literature. However, the literature is still unclear on an effective protocol for implant surface decontamination or the appropriate choice of regenerative materials. This case series describes a surgical technique to treat peri-implantitis osseous defects using a mixture of deproteinized bovine bone mineral with 10% porcine collagen (DBBM-C) in a block form, soaked in an appropriate antibiotic. The use of this combination provides advantages such as good graft adaptability along with localized antibiotic release without the use of systemic antibiotics. Thus, this technique might be an effective method to treat amenable peri-implantitis defects. Additionally, the proposed algorithm also allows for customized culture based antibiotic loading. To the best of the authors’ knowledge, this is the first case series documenting this technique for peri-implantitis defects. Long-term studies with controlled samples would be necessary for further evaluation.
... Among the available antibiotic molecules, tetracyclines were shown to be efficient, especially against subgingival microorganisms [20]. Tetracyclines, indeed, present an inhibiting action on destructive enzymes such as matrix metalloproteinases and collagenases. ...
... Tetracyclines, indeed, present an inhibiting action on destructive enzymes such as matrix metalloproteinases and collagenases. Besides, doxycycline stimulates osteoblasts by promoting cell maturation and differentiation and has a resulting healing effect on bone tissue [20]. ...
... Some studies assessed the efficacy of the administration of 14% doxycycline gel as a non-surgical adjuvant in the treatment of periodontitis [19]. Recently, two studies showed promising antimicrobial results using 14% doxycycline gel on implant surfaces [19,20]. However, neither of these studies evaluated the combined effect that the gel (which has to remain on the surface for 12 days and biodegrades 50 days after application) and the salivary microbes has on the smooth titanium surface of the implants. ...
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Article
Inflammatory diseases affecting the soft and hard tissues surrounding an implant represent a new challenge in contemporary implant dentistry. Among several methods proposed for the decontamination of titanium surfaces, the administration of topical 14% doxycycline gel seems to be a reliable option. In the present study, we evaluated the microbial effect of 14% doxycycline gel applied on titanium surfaces and exposed to human salivary microbes in anaerobic conditions. We also examined the composition of the exposed surfaces to assess the safe use of periodontal gel on titanium surfaces. Six anatase and six type 5 alloy titanium surfaces were used and divided into two groups: The test group and the positive control group. Both were cultured with human salivary samples in anaerobic conditions. On the test groups, 240 mg of periodontal gel was applied. The microbial assessment was performed with a colony-forming unit (CFU) count and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) to identify the species. The surface integrity was assessed using scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDS). The results demonstrated the microbial efficacy of the 14% doxycycline periodontal gel and its safe use on titanium surfaces. However, the SEM observations revealed the permanence of the gel on the titanium surfaces due to the physical composition of the gel. This permanence needs to be further investigated in vivo and a final polishing protocol on the titanium surface is recommended.
... In some case series and case reports, many encouraging results also emerged. Mensi et al. reported improvements in PPD and BOP using a Multiple Anti-Infective Non-Surgical Treatment (MAINST) protocol that consisted of two treatments, each executed in two consecutive weeks, based on air polishing, ultrasonic, manual debridement, chlorhexidine rinse, and a final pocket filling with doxycycline gel 14% (Ligosan ® Kulzer Gmbh, Hanau, Germany) [56]. The same results were also reported in Moura et al. and Diachova et al., where improvements in PD [57,58] and BOP [58] were registered after using local doxycycline. ...
... These findings were confirmed in a recent systematic review, which also demonstrated that the adjunctive treatment fails to facilitate the effectiveness of plaque removal in reducing PD (such as air abrasive device, systemic and local/topical antibiotics) and BOP (such as septic or systemic/local antibiotics) scores at the sites with peri-implant mucositis [5]. Contrarily, for non-surgical peri-implantitis treatment, the BOP scores favoured either local antibiotics [28,30,36,39,45,56,[61][62][63][64] adjunctive therapy or alternative plaque control measures [63] over respective control therapeutic managements. Therefore, from the above evidence, local/topical antibiotics as an adjunctive treatment are more effective in peri-implantitis than peri-implant mucositis. ...
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Article
Most studies indicate that the mechanical removal of the bacterial biofilm from the implant surface is the central goal of peri-implantitis therapy. However, controversial results in the treatment of peri-implantitis have led to the consideration of additional strategies that include surgical approaches and chemical adjuvants. Local/topical antibiotics, such as minocycline, azithromycin, tetracycline, amoxicillin, doxycycline, and metronidazole, may improve the efficacy of the definitive treatment of the disease, but the lack of conclusive findings prevents their use in clinical practice. This systematic review aimed to evaluate the effect of local/topical antibiotics for peri-implantitis treatment. Randomised controlled studies (RCT) on patients with peri-implantitis and comparing the efficacy of local/topical antibiotics vs. placebo or mechanical debridement were included. A systematic search strategy was carried out using three registered databases (PubMed, Web of Science, and Scopus). RoB2 was used to assess risk of bias. Five RCTs were identified (n = 250 patients and 333 implants). Contrast results emerged among the included studies, and a high heterogeneity level was observed. Risk of bias revealed some concerns for three studies out of five, while one study was judged at high risk. Only one study analysed the limitations of its findings. Overall, local antibiotic use can be considered a valid approach in the treatment of peri-implantitis. Therefore, future long-term clinical trials with standardised protocols and antibiotics with similar biological activity profiles should be tested to achieve a valid and definitive conclusion.
... Topical application of controlled-release doxycycline was included in an anti-infective non-surgical peri-implantitis treatment protocol, which demonstrated improvement of peri-implant health, considering the clinical parameters (35). A new gel was proposed, which included metronidazole and doxycycline in its formulation. ...
... The majority of the studies supported the topical application of tetracyclines in adjunct to the periodontitis and peri-implantitis treatment (24,25,27,29,30,(32)(33)(34)(35)37). One study reported debatable results because of the difficulty of removing completely one of the minocycline hydrochloride agents of the implant surface (39). ...
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Article
INTRODUCTION: Periodontitis and peri-implantitis are plaque-induced diseases, which are associated with certain bacteria. The conventional treatment aims primarily at tooth or implant surface debridement. In certain cases, surgical therapy is necessary. To improve the outcome of the treatment, systemic or topical antibiotics could be considered. AIM: The aim of this review is to investigate the effect of the adjunctive systemically or topically delivered antibiotics on the outcome of the periodontitis and peri-implantitis treatment. MATERIALS AND METHODS: Articles related to the topic were searched in the PubMed database. Articles published from 2000 to 2019, only in English language, were included in the review. The search was conducted with a variety of keywords in different combinations being used. These were: “periodontitis”, “peri-implantitis”, “antibiotic”, “local”, “metronidazole”, “amoxicillin”, “azithromycin”, “tetracycline”. RESULTS: Forty-seven articles were included in the review. The selected articles described the adjunctive systemic and/or local delivery of metronidazole, azithromycin, the combination of metronidazole and amoxicillin and some representatives of the tetracycline group, such as doxycycline and minocycline in cases of periodontitis and peri-implantitis. CONCLUSION: The adjunctive systemic and topical antibiotic therapy could benefit the outcome of periodontitis and peri-implantitis treatment.
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The role of antibiotics as adjunctive therapy in the non-surgical treatment of peri-implantitis is uncertain. The aim of this systematic review of randomized controlled trials was to assess the efficacy of antibiotic therapy, local or systemic, as an adjunctive to the non-surgical therapy of peri-implantitis. Primary outcomes were: implant success rate and complications, changes in radiographic bone level, probing pocket depth (PPD), probing attachment level (PAL), bleeding on probing (BOP) and peri-implantitis resolution. Six studies were included: two using topical and four systemic antibiotics. Adjunctive local antibiotics improved PPD (mean difference (MD) = 0.6 mm; 95% CI 0.42–0.78), BOP (MD = 0.15% (95% CI 0.10, 0.19)) and the success rate (risk ratio = 9.89; 95% CI 2.39–40.84). No significant difference in bone level and success rate were found with the use of systemic antibiotics, although they appeared to improve PPD (MD = 1.15 mm; 95% CI 0.31–1.99) and PAL (MD = 1.10 mm; 95% CI 0.13–2.08). Within the limitations of this review, the adjunctive local antibiotics showed improved outcomes in terms of success rate, PPD and BOP, while adjunctive systemic antibiotics improved PPD and PAL only. Peri-implantitis resolution was about 20–30% using adjunctive local antibiotics, whilst it ranged from 2% to 65% with adjunctive systemic antibiotics. Findings are still controversial, since they are based on few studies with high heterogeneity, at the uncertain or high risk of bias and involve few patients. Non-surgical debridement and maintenance periodontal support therapy remain pivotal and the adjunctive use of antibiotics for peri-implantitis cannot be routinely recommended, even considering the increasing concern on antibiotic resistance.
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Thesis
Abstract Introduction: Peri-implantitis is defined as an inflammatory process, with poly-microbial origin, that besides affecting soft tissues, causes the loss of bone tissue that supports the implant, being one of the main causes of failure in rehabilitation with implants. Currently, there is no consensual and standardized protocol for the treatment of peri-implant. However, the main objective of the treatment is to remove the biofilm therefore the purpose is to reach a peri-implant microbiological environment compatible with the bone formation around the implant. Objective: The objective of this systematic review is to evaluate the efficacy of current methodologies for the non-surgical treatment of peri-implantitis, through the evaluation of microbiological, clinical and radiographic data, with the finality to evaluate whether there are improvements with non-surgical therapy implants when compared with implants not subject to treatment. Materials and Methods: An electronic search was conducted in the following databases: PubMed/MEDLINE, Cochrane Library, Web of Science and EBSCO, in order to answer the following PICO question: “In patients with osteointegrated implants diagnosed with peri-implant what are the microbiological, clinical and radiographic results of non-surgical treatment of PI compared to no treatment?” Data collection ended in May 2020, with no restrictions on the type of publication, region or year. The search was limited to articles in English, Spanish and Portuguese. Results: A total of 597 articles were obtained, of which 63 were selected for full reading, after excluding duplicates and reading the title and abstract. Of these, 25 articles were included. A qualitative and quantitative analysis of the results obtained was carried out and systematically reviewed in tables. Discussion and Conclusion: Taking into account current review permissions, it can be concluded that, the non-surgical treatment detected is not effective in resolving pre-implanted data, despite the improvements in the analyzed parameters at the beginning, there is a trend to the disease reoccurrence. Keywords: peri-implantitis, non-surgical treatment, implant surface, decontamination, microbiology
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Aims: Over the past decades, the placement of dental implants has become a routine procedure in the oral rehabilitation of fully and partially edentulous patients. However, the number of patients/implants affected by peri-implant diseases is increasing. As there are--in contrast to periodontitis--at present no established and predictable concepts for the treatment of peri-implantitis, primary prevention is of key importance. The management of peri-implant mucositis is considered as a preventive measure for the onset of peri-implantitis. Therefore, the remit of this working group was to assess the prevalence of peri-implant diseases, as well as risks for peri-implant mucositis and to evaluate measures for the management of peri-implant mucositis. Methods: Discussions were informed by four systematic reviews on the current epidemiology of peri-implant diseases, on potential risks contributing to the development of peri-implant mucositis, and on the effect of patient and of professionally administered measures to manage peri-implant mucositis. This consensus report is based on the outcomes of these systematic reviews and on the expert opinion of the participants. Results: Key findings included: (i) meta-analysis estimated a weighted mean prevalence for peri-implant mucositis of 43% (CI: 32-54%) and for peri-implantitis of 22% (CI: 14-30%); (ii) bleeding on probing is considered as key clinical measure to distinguish between peri-implant health and disease; (iii) lack of regular supportive therapy in patients with peri-implant mucositis was associated with increased risk for onset of peri-implantitis; (iv) whereas plaque accumulation has been established as aetiological factor, smoking was identified as modifiable patient-related and excess cement as local risk indicator for the development of peri-implant mucositis; (v) patient-administered mechanical plaque control (with manual or powered toothbrushes) has been shown to be an effective preventive measure; (vi) professional intervention comprising oral hygiene instructions and mechanical debridement revealed a reduction in clinical signs of inflammation; (vii) adjunctive measures (antiseptics, local and systemic antibiotics, air-abrasive devices) were not found to improve the efficacy of professionally administered plaque removal in reducing clinical signs of inflammation. Conclusions: Consensus was reached on recommendations for patients with dental implants and oral health care professionals with regard to the efficacy of measures to manage peri-implant mucositis. It was particularly emphasized that implant placement and prosthetic reconstructions need to allow proper personal cleaning, diagnosis by probing and professional plaque removal.
Article
Background To develop preventive strategies addressing peri-implant diseases, a thorough understanding of the epidemiology is required.AimThe aim was to systematically assess the scientific literature in order to evaluate the prevalence, extent and severity of peri-implant diseases.Material & Methods Data were extracted from identified studies. Meta-analyses for prevalence of peri-implant mucositis and peri-implantitis were performed. The effect of function time and disease definition on the prevalence of peri-implantitis was evaluated by meta-regression analyses. Data on extent and severity of peri-implant diseases was estimated if not directly reported.Results15 articles describing 11 studies were included. Case definitions for mucositis and peri-implantitis varied. The prevalence of peri-implant mucositis and peri-implantitis ranged from 19-65% and from 1-47%, respectively. Meta-analyses estimated weighted mean prevalences of peri-implant mucositis and peri-implantitis of 43% (CI: 32-54%) and 22% (CI: 14-30%), respectively. The meta-regression showed a positive relationship between prevalence of peri-implantitis and function time and a negative relationship between prevalence of peri-implantitis and threshold for bone loss. Extent and severity of peri-implant diseases were rarely reported.Conclusion Future studies on the epidemiology of peri-implant diseases should consider (i) applying consistent case definitions and (ii) assessing random patient samples of adequate size and function time.This article is protected by copyright. All rights reserved.
Article
Peri-implant diseases are defined as inflammatory lesions of the surrounding peri-implant tissues and include peri-implant mucositis (an inflammatory lesion limited to the surrounding mucosa of an implant) and peri-implantitis (an inflammatory lesion of the mucosa that affects the supporting bone with resulting loss of osseointegration). This review aims to describe the different approaches to manage both entities and to provide a critical evaluation of the evidence available on their efficacy. Therapy of peri-implant mucositis and nonsurgical therapy of peri-implantitis usually involve mechanical debridement of the implant surface using curettes, ultrasonic devices, air-abrasive devices or lasers, with or without the adjunctive use of local antibiotics or antiseptics. The efficacy of these therapies has been demonstrated for mucositis: controlled clinical trials show an improvement in clinical parameters, especially in bleeding on probing. For peri-implantitis, the results are limited, especially in terms of probing pocket-depth reduction. Surgical therapy of peri-implantitis is indicated when nonsurgical therapy fails to control the inflammatory changes. Selection of the surgical technique should be based on the characteristics of the peri-implant lesion. In the presence of deep circumferential and intrabony defects, surgical interventions should aim to provide thorough debridement, implant-surface decontamination and defect reconstruction. In the presence of defects without clear bony walls or with a predominant suprabony component, the aim of the surgical intervention should be the thorough debridement and the repositioning of the marginal mucosa to enable the patient to perform effective oral-hygiene practices, although this aim may compromise the esthetic result of the implant-supported restoration.
Article
Objectives: The aim of this prospective, randomized, controlled clinical study was to compare the clinical outcomes of the subgingival treatment with erythritol powder by means of an air-polishing (EPAP) device and of scaling and root planing (SRP) during supportive periodontal therapy (SPT). Method and materials: 40 patients enrolled in SPT were randomly assigned to two groups of equal size. Sites had to show signs of inflammation (bleeding on probing [BOP]-positive) and a probing pocket depth (PPD) of ≥ 4 mm, however, without presence of detectable subgingival calculus. During SPT, these sites were treated with EPAP or SRP, respectively. Full mouth and site-specific plaque indices, BOP, PPD, and clinical attachment level (CAL) were recorded at baseline (BL) and at 3 months, whereas the percentage of study sites positive for BOP (BOP+) was considered as primary outcome variable. Additionally, patient comfort using a visual analog scale (VAS) and the time needed to treat per site was evaluated. Results: At 3 months, mean BOP level measured 45.1% at test sites and 50.6% at control sites, respectively, without a statistically significant difference between the groups (P > .05). PPD and CAL slightly improved for both groups with comparable mean values at 3 months. Evaluation of patient tolerance showed statistically significantly better values among patients receiving the test treatment (mean VAS [0-10], 1.51) compared to SRP (mean VAS [0-10], 3.66; P = .0012). The treatment of test sites was set to 5 seconds per site. The treatment of control sites, on the other hand, lasted 85 seconds on average. Conclusion: The new erythritol powder applied with an air-polishing device can be considered a promising modality for repeated instrumentation of residual pockets during SPT. Clinical relevance: With regard to clinical outcomes during SPT, similar results can be expected irrespective of the two treatment approaches of hand instrumentation or subgingival application of erythritol powder with an air-polishing device in sites where only biofilm removal is required.
Article
The effects of sugar alcohols such as erythritol, xylitol, and sorbitol on periodontopathic biofilm are poorly understood, though they have often been reported to be non-cariogenic sweeteners. In the present study, we evaluated the efficacy of sugar alcohols for inhibiting periodontopathic biofilm formation using a heterotypic biofilm model composed of an oral inhabitant Streptococcus gordonii and a periodontal pathogen Porphyromonas gingivalis. Confocal microscopic observations showed that the most effective reagent to reduce P. gingivalis accumulation onto an S. gordonii substratum was erythritol, as compared with xylitol and sorbitol. In addition, erythritol moderately suppressed S. gordonii monotypic biofilm formation. To examine the inhibitory effects of erythritol, we analyzed the metabolomic profiles of erythritol-treated P. gingivalis and S. gordonii cells. Metabolome analyses using capillary electrophoresis time-of-flight mass spectrometry revealed that a number of nucleic intermediates and constituents of the extracellular matrix, such as nucleotide sugars, were decreased by erythritol in a dose-dependent manner. Next, comparative analyses of metabolites of erythritol- and sorbitol-treated cells were performed using both organisms to determine the erythritol-specific effects. In P. gingivalis, all detected dipeptides, including Glu-Glu, Ser-Glu, Tyr-Glu, Ala-Ala and Thr-Asp, were significantly decreased by erythritol, whereas they tended to be increased by sorbitol. Meanwhile, sorbitol promoted trehalose 6-phosphate accumulation in S. gordonii cells. These results suggest that erythritol has inhibitory effects on dual species biofilm development via several pathways, including suppression of growth resulting from DNA and RNA depletion, attenuated extracellular matrix production, and alterations of dipeptide acquisition and amino acid metabolism.
Article
Use of logical constraints among hypotheses and correlations among test statistics can greatly improve the power of step-down tests. An algorithm for uncovering these logically constrained subsets in a given dataset is described. The multiple testing results are summarized using adjusted p values, which incorporate the relevant dependence structures and logical constraints. These adjusted p values are computed consistently and efficiently using a generalized least squares hybrid of simple and control-variate Monte Carlo methods, and the results are compared to alternative stepwise testing procedures.
Article
Objective: The objective of the study is to compare the clinical, microbiological and host-derived effects in the non-surgical treatment of initial peri-implantitis with either adjunctive local drug delivery (LDD) or adjunctive photodynamic therapy (PDT) after 12 months. Materials and methods: Forty subjects with initial peri-implantitis, that is, pocket probing depths (PPD) 4-6 mm with bleeding on probing (BoP) and radiographic bone loss ≤2 mm, were randomly assigned to two treatment groups. All implants were mechanically debrided with titanium curettes and with a glycine-based powder airpolishing system. Implants in the test group (N = 20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri-implant pockets of control implants (N = 20). At sites with residual BoP, treatment was repeated after 3, 6, 9 and 12 months. The primary outcome variable was the change in the number of peri-implant sites with BoP. Secondary outcome variables included changes in PPD, clinical attachment level (CAL), mucosal recession (REC) and in bacterial counts and crevicular fluid (CF) levels of host-derived biomarkers. Results: After 12 months, the number of BoP-positive sites decreased statistically significantly (P < 0.05) from baseline in both groups (PDT: 4.03 ± 1.66-1.74 ± 1.37, LDD: 4.41 ± 1.47-1.55 ± 1.26). A statistically significant (P < 0.05) decrease in PPD from baseline was observed at PDT-treated sites up to 9 months (4.19 ± 0.55 mm to 3.89 ± 0.68 mm) and up to 12 months at LDD-treated sites (4.39 ± 0.77 mm to 3.83 ± 0.85 mm). Counts of Porphyromonas gingivalis and Tannerella forsythia decreased statistically significantly (P < 0.05) from baseline to 6 months in the PDT and to 12 months in the LDD group, respectively. CF levels of IL-1β decreased statistically significantly (P < 0.05) from baseline to 12 months in both groups. No statistically significant differences (P > 0.05) were observed between groups after 12 months with respect to clinical, microbiological and host-derived parameters. Conclusions: Non-surgical mechanical debridement with adjunctive PDT was equally effective in the reduction of mucosal inflammation as with adjunctive delivery of minocycline microspheres up to 12 months. Adjunctive PDT may represent an alternative approach to LDD in the non-surgical treatment of initial peri-implantitis.
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
To review and discuss current literature on the use of systemically administered or locally delivered antibiotics in the treatment of peri-implantitis. A literature search was conducted using MEDLINE through the PubMed database of the US National Library of Medicine using studies up to 2011. Studies on the microbiology of peri-implantitis lesions were hand selected. Two studies on the use of systemically administered antibiotics in the treatment of peri-implantitis were identified. Both studies involved a case series without controls. Five studies on locally delivered antibiotics were found. In all cases, local antibiotics were used in conjunction with mechanical debridement and chemical disinfection with antimicrobial agents such as chlorhexidine digluconate or hydrogen peroxide. The additional effects of local antibiotics were noted in all studies but were in general moderate. This may in part be due to the selection of patients with advanced deep pockets and advanced bone loss. The current available scientific information on the use of locally or systemically administered antibiotics is insufficient to allow any firm specific recommendations for the use of these drugs. Local application of minocycline or doxycycline as an adjunct to mechanical debridement and irrigation with an antimicrobial agent may be effective in moderately deep lesions. Surgical access by full-thickness flap surgery in deeper lesions is probably necessary to halt the progression of bone loss. No sound scientific basis is available for the use of systemic antibiotics. There is an urgent need for randomised clinical trials on the use of antibiotics in the treatment of peri-implantitis. Proper periodontal infection control in dentate patients before implants are installed and frequent supportive implant care represent effective measures to reduce the risk of future infections and their complications around oral implants.
Article
Abstract This study was designed to histologically determine the relationship of the periodontal probe tip to the periodontal tissues during probing of untreated periodontal pockets and periodontal pockets treated with oral hygiene and root planing. Human, condemned, single rooted teeth with buccal probing pocket depth at least 6 mm were used. Two groups of specimens were included: 12 untreated teeth from six patients and 15 treated teeth from 10 patients. In the treated group, the effects of therapy were monitored clinically every 2 weeks until maximum improvement had taken place. A periodontal probe tip was then inserted on the buccal aspect of the tooth using 0.50 N pressure, and block section biopsies were taken. The histologic examination of the untreated teeth showed that the probe tip penetrated beyond the apical termination of the functional epithelium and into the subjacent connective tissue by a mean of 0.45 ±0.34 mm, whereas in the treated specimens the probe stopped coronally to this landmark by a mean of 0.73±0.80 mm. This study demonstrated that the probe tip most often does not reach the base of the junctional epithelium in pockets treated by plaque control and root planing, and that clinical measurements of attachment levels are not reliable in determining the true histologic level of connective tissue attachment.
Article
To evaluate the probing depth at implants with signs of peri-implantitis before and following the removal of the prosthetic reconstructions and its relation with the peri-implant bone level as revealed by open access flap surgery. Twenty-nine patients with 89 implants with diagnosis of peri-implantitis were included in the study. The probing pocket depth at implants before (PPD-1) and following (PPD-2) the removal of the prosthetic reconstructions was measured at four sites of the implants. These measurements were also analysed in relation to the amount of peri-implant bone loss measured during peri-implant surgery. The results showed that in only 119 (37%) of the sites, the measurements were similar between PPD-1 and PPD-2; in 124 sites (39%), the difference was ±1 mm, in 47 sites (15%) it was ±2 mm and in the rest of the sites it was ±3 mm. A high linear and statistically significant (P = <0.001) correlation between PPD-2 and the bone loss measured at implants for all and single surfaces was observed (r = 0.67, range 0.64–0.69), while PPD-1 yielded a weak and no statistically significant correlation (r = 0.35, range 0.27–0.42). The analysis of the bone loss at implants showed that 59 implants (66%) had an amount of bone loss that was similar at all the four surfaces, while in 30 implants, the bone loss differed for the various sites. A higher extent of bone loss was often detected at the buccal compared with the other sites. The results of this study yielded differences in the pocket probing measurements at implants with or without the prosthetic reconstruction in place and that the probing pocket depth following the removal of the prosthesis had a high correlation with the amount of bone loss at implants assessed during surgery.
Article
The aim of this prospective, parallel group designed, randomized controlled clinical study was to evaluate the effectiveness of an air-abrasive device (AAD) for non-surgical treatment of peri-implantitis. Thirty patients, each of whom displayed at least one implant with initial to moderate peri-implantitis, were enrolled in an oral hygiene program (OHI) and randomly instrumented using either (1) AAD (amino acid glycine powder) or (2) mechanical debridement using carbon curets and antiseptic therapy with chlorhexidine digluconate (MDA). Clinical parameters were measured at baseline, 3 and 6 months after treatment [e.g. bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL)]. At 6 months, AAD group revealed significantly higher (p<0.05; unpaired t-test) changes in mean BOP scores when compared with MDA-treated sites (43.5 ± 27.7%versus 11.0 ± 15.7%). Both groups exhibited comparable PD reductions (AAD: 0.6 ± 0.6 mm versus MDA: 0.5 ± 0.6 mm) and CAL gains (AAD: 0.4 ± 0.7 mm versus MDA: 0.5 ± 0.8 mm) (p>0.05; unpaired t-test, respectively). Within its limitations, the present study has indicated that (i) both treatment procedures resulted in comparable but limited CAL gains at 6 months, and (ii) OHI+AAD was associated with significantly higher BOP reductions than OHI+MDA.
Article
Peri-implant diseases present in two forms - peri-implant mucositis and peri-implantitis. The literature was systematically searched and critically reviewed. Four manuscripts were produced in specific topics identified as key areas to understand the microbial aetiology and the pathogenesis of peri-implant diseases and how the implant surface structure may affect pathogenesis. While peri-implant mucositis represents the host response of the peri-implant tissues to the bacterial challenge that is not fundamentally different from gingivitis representing the host response to the bacterial challenge in the gingiva, peri-implantitis may differ from periodontitis both in the extent and the composition of cells in the lesion as well as the progression rate. A self-limiting process with a "protective" connective tissue capsule developing appears to dominate the periodontitis lesion while such a process may occasionally be lacking in peri-implantitis lesions. Bacterial biofilm formation on implant surfaces does not differ from that on tooth surfaces, but may be influenced by surface roughness. Nevertheless there is no evidence that such differences may influence the development of peri-implantitis. It was agreed that clinical and radiographic data should routinely be obtained after prosthesis installation on implants in order to establish a baseline for the diagnosis of peri-implantitis during maintenance of implant patients.
Article
To describe the microbiota associated with peri-implant disease, with a specific emphasis on the differential diagnosis of the condition. The potentially relevant literature was preliminarily assessed via scoping searches to find the most appropriate search terms and the most efficient Boolean search algorithm. We identified 29 reports on subjects with osseointegrated implants, with a pathological condition compatible with the definition of "peri-implant disease", and reporting microbiological data from samples taken in affected sites. In most studies bacterial samples were obtained by methods that destroy the three-dimensional structure of the biofilm. The samples therefore describe mixtures of bacteria from unspecified districts of biofilm associated with peri-implant diseases. Analyses of such samples with various methods indicate that peri-implant disease maybe viewed as a mixed anaerobic infection. In most cases the composition of the flora is similar to the subgingival flora of chronic periodontitis that is dominated by Gram-negative bacteria. Peri-implant infections may occasionally be linked to a different microbiota, including high numbers of peptostreptococci or staphylococci. Beneficial effects of mechanical and chemical interventions to disrupt the peri-implant biofilm demonstrate that microorganisms are involved in the disease process, even if they may not always be the origin of the condition.
Article
Non-surgical peri-implantitis therapies appear to be ineffective. Limited data suggest that ER:YAG laser therapy improves clinical conditions. The present study aimed at comparing the treatment effects between air-abrasive (AM) and Er:YAG laser (LM) mono-therapy in cases with severe peri-implantitis. Twenty-one subjects in each group were randomly assigned to one time intervention by an air-abrasive device or an Er:YAG laser. Clinical data were collected before treatment and at 6 months. Data analysis was performed using repeat univariate analysis of variance controlling for subject factors. No baseline subject characteristic differences were found. Bleeding on probing and suppuration decreased in both the groups (p<0.001). The mean probing depth (PPD) reductions in the AM and LM groups were 0.9 mm (SD 0.8) and 0.8 mm (SD ± 0.5), with mean bone-level changes (loss) of -0.1 mm (SD ± 0.8) and -0.3 mm (SD ± 0.9), respectively (NS). A positive treatment outcome, PPD reduction ≥0.5 mm and gain or no loss of bone were found in 47% and 44% in the AM and LM groups, respectively. The clinical treatment results were limited and similar between the two methods compared with those in cases with severe peri-implantitis.
Article
Peri-implantitis is a frequent finding in patients with dental implants. The present study compared two non-surgical mechanical debridement methods of peri-implantitis. Thirty-seven subjects (mean age 61.5; S.D+/-12.4), with one implant each, demonstrating peri-implantitis were randomized, and those treated either with titanium hand-instruments or with an ultrasonic device were enrolled. Data were obtained before treatment, and at 1, 3, and 6 months. Parametric and non-parametric statistics were used. Thirty-one subjects completed the study. The mean bone loss at implants in both groups was 1.5 mm (SD +/-1.2 mm). No group differences for plaque or gingival indices were found at any time point. Baseline and 6-month mean probing pocket depths (PPD) at implants were 5.1 and 4.9 mm (p=0.30) in both groups. Plaque scores at treated implants decreased from 73% to 53% (p<0.01). Bleeding scores also decreased (p<0.01), with no group differences. No differences in the total bacterial counts were found over time. Higher total bacterial counts were found immediately after treatment (p<0.01) and at 1 week for ultrasonic-treated implants (p<0.05). No group differences were found in the treatment outcomes. While plaque and bleeding scores improved, no effects on PPD were identified.
Article
The aim of the present study was to describe some clinical periodontal features of partially edentulous patients referred for the treatment of peri-implantitis. The 23 subjects involved in this study were selected from consecutive patients referred to the department of Periodontology Södra Alvsborgs Hospital, Borås, Sweden, for treatment of peri-implantitis during 2006. The patients had clinical signs of peri-implantitis around one or more dental implants (i.e.>or=6 mm pockets, bleeding on pockets and/or pus and radiographic images of bone loss to>or=3 threads of the implants) and remaining teeth in the same and/or opposite jaw. The following clinical variables were recorded: Plaque Index (PI), Gingival Bleeding Index (GBI) Probing Pocket Depth (PPD), Access/capability to oral hygiene at implant site (yes/no), Function Time. The patients were categorized in the following sub-groups: Periodontitis/No periodontitis, Bone loss/No bone loss at teeth, Smoker/Non-smokers. Out of the 23 patients, the majority (13) had minimal bone loss at teeth and no current periodontitis; 5 had bone loss at teeth exceeding 1/3 of the length of the root but not current periodontitis and only 5 had current periodontitis. Six patients were smokers (i.e. smoking more than 10 cig/day). The site level analysis showed that only 17 (6%) of the 281 teeth present had >or=1 pocket of >or=6mm, compared to 58 (53%) of the total 109 implants (28 ITI and 81 Brånemark); 74% of the implants had no accessibility to proper oral hygiene. High proportion of implants with diagnosis of peri-implantitis were associated with no accessibility/capability for appropriate oral hygiene measures, while accessibility/capability was rarely associated with peri-implantitis. Indeed 48% of the implants presenting peri-implantitis were those with no accessibility/capability for proper oral hygiene (65% positive predict value) with respect to 4% of the implants with accessibility/capability (82% negative predict value). The results of the study indicate that local factors such as accessibility for oral hygiene at the implant sites seems to be related to the presence or absence of peri-implantitis. Peri-implantitis was a frequent finding in subjects having signs of minimal loss of supporting bone around the remaining natural dentition and no signs of presence of periodontitis (i.e. presence of periodontal pockets of >or=6 mm at natural teeth). Only 6 of the examinated subjects were smokers. In view of these results we should like to stress the importance of giving proper oral hygiene instructions to the patients who are rehabilitated with dental implant and of proper prosthetic constructions that allow accessibility for oral hygiene around implants.
Article
Peri-implant diseases include peri-implant mucositis, describing an inflammatory lesion of the peri-implant mucosa, and peri-implantitis, which also includes loss of supporting bone. A literature search of the Medline database (Ovid), up to 21 January 2008 was carried out using a systematic approach, in order to review the evidence for diagnosis and the risk indicators for peri-implant diseases. Experimental and clinical studies have identified various diagnostic criteria including probing parameters, radiographic assessment and peri-implant crevicular fluid and saliva analyses. Cross-sectional analyses have investigated potential risk indicators for peri-implant disease including poor oral hygiene, smoking, history of periodontitis, diabetes, genetic traits, alcohol consumption and implant surface. There is evidence that probing using a light force (0.25 N) does not damage the peri-implant tissues and that bleeding on probing (BOP) indicates presence of inflammation in the peri-implant mucosa. The probing depth, the presence of BOP, and suppuration should be assessed regularly for the diagnosis of peri-implant diseases. Radiographs are required to evaluate supporting bone levels around implants. The review identified strong evidence that poor oral hygiene, a history of periodontitis and cigarette smoking, are risk indicators for peri-implant disease. Future prospective studies are required to confirm these factors as true risk factors.
Article
The purpose of this study was to investigate the possibility of antimicrobial treatment of peri-implant infections associated with a periodontitis-like subgingival microbiota. Nine partially or fully edentulous patients with titanium hollow cylinder implants were selected which showed loss of bone and probing depths > or = 5 mm on one or several implants after at least 6 months following installation. They also yielded subgingival microbial samples with > or = 10(6) CFU/ml, including > or = 20% gram-negative anaerobic bacteria. The treatment included mechanical cleaning, irrigation of all peri-implant pockets > 3 mm with 0.5% chlorhexidine and systemic antimicrobial therapy (1000 mg ornidazole for 10 consecutive days). After therapy, bleeding scores decreased immediately and, over a one-year observation period, remained significantly lower than before treatment. A significant gradual reduction in mean probing depths was detected over this one-year period; only one case showed no improvement of local probing depth. Microbiological parameters indicated an instantaneous quantitative and qualitative change following treatment. Subsequently, several of these parameters tended to shift back towards pretreatment values. In the second half of the observation period, however, this tendency was reversed, and levels significantly different from baseline were eventually established. This study demonstrated that treatment aiming at reducing the subgingival bacterial mass and suppressing the anaerobic segment had a beneficial effect in patients suffering from peri-implantitis.
Article
The purpose of this study was to compare the clinical and microbiological (microscopic) parameters during the development of experimental gingivitis and experimental peri-implant mucositis. Twenty partially edentulous patients were treated for moderate to advanced periodontal disease. Following active periodontal therapy consisting of motivation, instruction in oral hygiene practices, scaling and root planing and periodontal surgery where indicated, IMZ oral implants were incorporated in posterior edentulous areas. After 3 months of healing, the prosthetic abutments were connected, and the patients were closely supervised for another 2 months of healing. At this time, baseline data were obtained. Re-examinations were scheduled at 3 and 6 months. Following this, the patients were asked to refrain from oral hygiene practices for 3 weeks. At all examinations including the end of the period of no oral hygiene, the following clinical parameters were obtained: Plaque Index, Gingival Index and Sulcus Bleeding Index, all modified by Mombelli et al. (1987), probing pocket depths and recession in mm. Furthermore, submucosal/subgingival plaque samples were obtained and analyzed using phase contrast microscopy. At the end of the 3-week period of plaque accumulation, optimal oral hygiene was reinstituted. There were no statistically significant differences between the mean values of all parameters at implant compared to tooth sites at any observation periods. The period of no oral hygiene demonstrated a similar cause-effect relationship between the accumulation of bacterial plaque and the development of peri-implant mucositis as established for the gingival units by the experimental gingivitis model.
Article
The purpose of this study was to investigate the clinical, microbiological and radiological effects of peri-implantitis therapy by local delivery of tetracycline. In 25 partially edentulous patients, 30 implants with radiographic evidence of circumferential bone loss, and peri-implant probing depths greater than or equal to 5 mm were treated with polymeric tetracycline HCI-containing fibers. Clinical and microbial parameters were recorded at baseline, and 1, 3, 6, and 12 months (M) after treatment. Standardized radiographs were obtained at baseline, M3, and one year after treatment. Two patients were discontinued from the study after 180 days because of persisting active peri-implantitis with pus formation. The remaining subjects showed a significant decrease of mean peri-implant probing depth from 6.0 to 4.1 mm (M1, P<0.001), which was maintained over 12 months. In comparison to baseline, the bleeding tendency was significantly reduced after one month, and therafter (P<0.001). No significant recession of the mucosal margin was noted. The radiologically determined distance from the shoulder of the implant to the bottom of the bony defect decreased slightly, bun not significantly, from 5.2 to 4.9 mm. At M1, M3 and M6, mean total anaerobic cultivable bacterial counts were significantly lower than at baseline (P<0.001). A significant decrease in frequency of detection was noted for Prevotella intermedia/nigrescens, Fusobacterium sp., Bacteroides forsythus, and Campylobacter rectus (P<0.01). Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Eikenella corrodens had very low baseline frequencies that could not be significantly suppressed further. In conclusion, therapy of peri-implantitis by local delivery of tetracycline had a positive effect on clinical and microbiological parameters.
Article
Evaluation of the clinical effect of topical application of doxycycline adjunctive to non-surgical periodontal therapy. A total of 111 patients suffering from untreated or recurrent moderate to severe periodontitis at 3 different centers (Heidelberg, Frankfurt, Nijmegen) were treated in this double-blind split-mouth study. In each patient, 3 different treatment modalities were assigned randomly to 3 test teeth: scaling and root planing alone (SRP), SRP with subgingival vehicle control (VEH), and SRP with subgingival application of a newly developed biodegradable 15% doxycycline gel (DOXI). At baseline, clinical parameters were measured at all single rooted teeth using a reference splint: PlI, PPD, relative attachment level (RAL-V), GI. 3 strata were generated according to baseline PPD: (i) 5-6 mm, (ii) 7-8 mm, (iii) > or =9 mm. Not more than 50% active smokers were allowed to each stratum. 3 and 6 months after therapy re-examination was performed by examiners blinded to baseline data and test sites. The statistical comparison of RAL-V gain and PPD reduction between the treatments was based on a repeated measures ANOVA with correction according to Huynh & Feldt. The comparison of SRP versus DOXI was considered as the main study question. 110 patients finished the 3 months and 108 the 6 months examination. The study did not show adverse effects of VEH or DOXI except for one singular inflammation that occurred 2 months after application of the doxycycline gel. DOXI provided statistically significantly more favorable PPD reduction (SRP: -2.4+/-1.4 mm, VEH: -2.7+/-1.6 mm, DOXI: -3.1+/-1.2 mm; SRP versus DOXI p=0.0001, VEH versus DOXI p=0.0066) and RAL-V gain (SRP: 1.6+/-1.9 mm, VEH: 1.6+/-2.2 mm, DOXI: 2.0+/-1.7 mm; SRP versus DOXI p=0.027, VEH versus DOXI p=0.038) than SRP and VEH after 6 months. Adjunctive topical subgingival application of a biodegradable 15% doxycycline gel was safe and provided more favorable RAL-V gain and PPD reduction than SRP alone and VEH. Thus, by use of topical doxycycline the threshold for surgical periodontal therapy might be moved toward deeper pockets.
Article
The purpose of this study was to obtain a better understanding of probing measurements around osseointegrated oral implants. A comparison was made of probe tip position around Astra Tech implants and teeth of eight cynomolgus monkeys (Macaca fascicularis) in conditions of i) healthy peri-implant mucosa/gingiva, ii) mild mucositis/gingivitis, iii) severe mucositis/gingivitis or iv) peri-implantitis/periodontitis. Histological sections of 128 probes that were attached to implants or teeth with surrounding tissues were prepared by the cutting-grinding technique. No systematic differences were identified in the clinical and histological estimates of the distance between the mucosal/gingival margin and the probe tip. The differences were mainly smaller than 0.5 mm, and in no case were they larger than 0.7 mm. For implants and teeth with healthy peri-implant mucosa/gingiva, the distance between the probe tip and the alveolar bone was similar and ranged from 0.5 to 1.5 mm (P = 0.97). However, the probe tip was closer to bone around implants than around teeth in conditions of mild mucositis/gingivitis (P = 0.034), severe mucositis/gingivitis (P < or = 0.0001) and peri-implantitis/periodontitis (P < or = 0.0001). Around implants with severe mucositis and peri-implantitis, the distance was generally smaller than 0.5 mm, whereas teeth with severe gingivitis and periodontitis showed distances that mainly ranged from 0.5 to 1.5 mm. In conclusion, the probing measurements around osseointegrated oral implants and teeth were different. Even mild marginal inflammation was associated with deeper probe penetration around implants in comparison to teeth.
Article
This study was aimed at assessing the efficacy of subgingival plaque removal in buccal and lingual sites during supportive periodontal therapy (SPT) using a novel low abrasive air-polishing powder. In 27 SPT patients, subgingival debridement was performed using the novel air-polishing powder (test) and hand instruments (positive control) in a randomized split mouth design. Before and immediately after treatment, subgingival plaque samples were taken from two teeth with pockets of 3-5 mm depth in both groups. To assess the influence of plaque sampling on the microflora, samples were also taken twice from two untreated teeth (negative control). The mean reduction in total colony forming units (CFU) was assessed by anaerobic culture. The patients' perception of treatment was assessed by a visual analog score (VAS). Therapy and plaque sampling were repeated after a 3-month interval. Test treatment resulted in a significantly greater reduction in mean CFU than positive control treatment (log 1.7+/-0.98 and log 0.61+/-0.79 respectively; p<0.05). Following both treatments, the CFU reduction was significantly greater compared to negative control treatment (log 0.06+/-0.49; p<0.05). In addition, test treatment was perceived as significantly more pleasant than hand instrumentation (p<0.05). The novel low abrasive air-polishing powder is superior to curettes in removing subgingival plaque from pockets of 3-5 mm depth in supportive periodontal therapy and offers greater patient comfort.
Article
Unlabelled: With the increased use of osseointegrated implants and with many implants functioning for a long time, the treatment of peri-implantitis has become important. Animal studies and clinical case reports have shown that the principle of guided bone regeneration can be applied to the surgical treatment of moderate to profound loss of bone around the implant, but we have found no published clinical studies. Patients and methods: Twenty-eight patients whose ages ranged from 25 to 78 years and who had a total of 48 peri-implant defects were examined at baseline (week 0) and after 18 weeks. This included the recording of bleeding on probing, pocket probing depths, and probing attachment levels at six sites for each tooth. For 2-18 weeks before week 0 all patients had been treated for peri-implantitis, including motivation, instruction in oral hygiene, and implant scaling with a hand plastic instrument. They were then randomly allocated to continue with this treatment or to have in addition mechanical debridement and local application of Atridox trade mark which slowly release doxycycline. Results: Patients treated with Atridox trade mark showed a significantly greater gain in mean (S.D.) probing attachment levels than those not treated with Atridox. Only subjects treated with Atridox had a significant gain in mean bleeding on probing (P = 0.001). Application of the biodegradable sustained release device after initial periodontal treatment resulted in a significant gain in mean probing attachment levels in the Atridox trade mark group and a significant reduction in pocket probing depths. There was also a significant difference in mean probing attachment levels (0.6mm).
Article
To compare the effectiveness of treatment of peri-implantitis with a novel ultrasonic device, the Vector system, with that of subgingival debridement with carbon fiber curettes. The study, comprising 11 patients with at least two screw type implants with bleeding on probing (BOP), probing pocket depth (PPD) > or =5 mm, and at least 1.5 mm radiographic bone loss and exposed implant threads, was carried out as a single blind randomized clinical trial. At baseline one randomly chosen implant in each patient was treated by the Vector system (test) while the other implant (control) was treated by submucosal debridement with a carbon fiber curette. After 3 months, the same treatments were repeated. Plaque, BOP, and PPD were recorded on all implant surfaces at baseline, and after 3 and 6 months. Bone levels were recorded on radiographs taken prior to the start of the study, and after 6 months. Oral hygiene around both test and control implants was improved at 3 and 6 months compared with baseline. At 6 months, four of the Vector-treated sites, and only one site treated with curettes, had stopped to bleed. In neither the test nor the control group, were there any differences between baseline and 6 months regarding PPD and bone levels. Although there was a greater reduction in the number of sites with BOP following treatment with the Vector system than following instrumentation with carbon fiber curettes, there was no significant difference between the two methods.
Article
This randomized clinical trial presents a 12-month follow-up of the clinical and microbiological results after application of minocycline microspheres as an adjunct to mechanical treatment of incipient peri-implant infections compared with an adjunctive treatment using 1% chlorhexidine gel application. Thirty-two subjects with probing depth > or =4 mm, combined with bleeding and/or exudate on probing and presence of putative pathogenic bacteria were given oral hygiene instructions and mechanical treatment of infected areas adjacent to implants. The subjects were then randomly assigned adjunctive subgingival antimicrobial treatment using either chlorhexidine gel or minocycline microspheres. Sixteen patients in the minocycline group and 14 in the chlorhexidine group completed the study. Follow-up examinations were carried out after 10 days, 1, 2, 3, 6, 9 and 12 months. The adjunctive use of minocycline microspheres resulted in improvements of probing depths and bleeding scores, whereas the adjunctive use of chlorhexidine only resulted in limited reduction of bleeding scores. For the deepest sites of the treated implants in the minocycline group, the mean probing depth was reduced from 5.0 to 4.4 mm at 12 months. This study could not show any significant difference in the levels of bacterial species or groups at any time point between the two antimicrobial agents tested. The present findings encourage further studies on adjunctive use of minocycline microspheres in the treatment of peri-implant lesions. The use of a local antibiotic as an adjunct to mechanical treatment of incipient peri-implantitis lesions demonstrated improvements in probing depths that were sustained over 12 months.
Article
With the help of so-called controlled release delivery systems, the half-life period of locally administered antibiotics in gingival crevicular fluid (GCF) can be extended significantly. The aim of this study was to characterize the delivery profile of a new one-component 14% doxycycline free amine gel for local application. Pharmacokinetics of doxycycline (DOXY) were analyzed in GCF, saliva, and serum. Twenty patients with persisting or recurring pockets (probing depths > or = 5 mm and bleeding on probing) after mechanical treatment (surgical or non-surgical) took part in the study. In each patient 1 periodontal defect was treated with DOXY gel. Samples of GCF, saliva, and serum were obtained before application of DOXY gel; 15 minutes after application; at 2 and 5 hours; and at 1, 2, 3, 4, 7, 9, and 11 days after application. Separation and quantitative measurement of DOXY was performed with high performance liquid chromatography and UV detection at lambda = 260 nm. Coefficients of variation were lower than 2% (intraassay) and 4% (interassay), respectively. For concentrations between 50 to 1000 microg/ml, we found a linear relationship between expected and measured DOXY values (linear coefficient of correlation: r = 0.998). Within the first 5 hours after application, concentration of DOXY in GCF (maximum after 15 minutes 19.97 +/- 5.85 mg/ml) and saliva (maximum after 15 minutes 17.83 +/- 2.84 mg/ml) was similar. Then concentration fell to a lower level (28.90 +/- 19.44 microg/ml) compared to GCF (577.41 +/- 127.34 microg/ml) after 3 days. Up to 10 days after application, the concentration of DOXY in GCF was 34.24 microg/ml. With the exception of 1 patient, all serum samples were DOXY-negative. 1) After subgingival application of biodegradable 14% doxycycline gel, mean doxycycline levels in GCF that exceeded 16 microg/ml could be maintained for at least 12 days. Thus, the antimicrobial agent may be classified as a controlled release device. 2) The antibiotic effect was limited mainly to the subgingival sites of application of the doxycycline gel. 3) The doxycycline gel possesses the pharmacokinetic and clinical properties to deliver efficacious levels of antibiotics to the periodontal pocket and to maintain these levels for at least 1 week without the need of further drug retention by a periodontal dressing.
Article
To monitor over 12 months clinical and radiographic changes occurring after adjunctive local delivery of minocycline microspheres for the treatment of peri-implantitis. In 25 partially edentulous subjects, 31 implants diagnosed with peri-implantitis were treated. Three weeks after oral hygiene instruction, mechanical debridement and local antiseptic cleansing using 0.2% chlorhexidine gel, baseline (Day 0) parameters were recorded. Minocycline microspheres (Arestin) were locally delivered to each implant site with bone loss and a probing pocket depth (PPD) >or=5 mm. Rescue therapy with Arestin was allowed at Days 180 and 270 at any site exhibiting an increase in PPD>or=2 mm from the previous visit. The following clinical parameters were recorded at four sites/implant at Day 0, 10, 30, 60, 90, 180, 270 and 360: PPD, clinical attachment level (CAL), bleeding on probing (BOP) and plaque index (PlI). Six implants in six subjects were either rescued or exited because of persisting active peri-implantitis. Successful implants showed a statistically significant reduction in both PPD and percentage of sites with BOP between baseline and Day 360 (P<0.05). At mesial implant sites, the mean PPD reduction amounted to 1.6 mm (95% CI: 0.9-2.2 mm, P<0.001) and was accompanied by a statistically significant reduction of the BOP value (P<0.001). Binary regression analysis showed that the clinical parameters and smoking history could not discriminate between successfully treated and rescued or exited implants at any observation time point. Non-surgical mechanical treatment of peri-implantitis lesions with adjunctive local delivery of microencapsulated minocycline led to positive effects on clinical parameters up to 12 months.
Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up
  • F O Costa
  • S Takenaka-Martinez
  • Lom Cota
  • S D Ferreira
  • Glm Silva
  • J E Costa
Costa FO, Takenaka-Martinez S, Cota LOM, Ferreira SD, Silva GLM, Costa JE. Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up. Journal of clinical Periodontology 2012;39:173-81.
  • D Herrera
  • B Alonso
  • L De Arriba
  • Santa Cruz
  • I Serrano C
  • M Sanz
Herrera D, Alonso B, de Arriba L, Santa Cruz I, Serrano c, Sanz M. acute periodontal lesions. Periodontol 2000 2014;65:149-77.
The authors wish to express their gratitude to A. Sordillo and G. Garzetti (University of Brescia) for their contributions in the clinical work related to this study
  • Acknowledgements
Acknowledgements.-The authors wish to express their gratitude to A. Sordillo and G. Garzetti (University of Brescia) for their contributions in the clinical work related to this study.