Article

Non-surgical treatment of peri-implantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine: a prospective, randomized, controlled clinical study. J Clin Periodontol

Department of Oral Surgery, Heinrich Heine University, Düsseldorf, Germany.
Journal Of Clinical Periodontology (Impact Factor: 4.01). 09/2011; 38(9):872-8. DOI: 10.1111/j.1600-051X.2011.01762.x
Source: PubMed

ABSTRACT

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.

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    • "Zahlreiche prospektive randomisierte klinische Vergleichsstudien belegen, dass ein konventionelles mechanisches Debridement mittels Handinstrumenten und lokaler Applikation von Chlorhexidindigluconat eine nur begrenzte Effektivität bei der nicht-chirurgischen Therapie der Periimplantitis zu haben scheint [15]. Durch den adjuvanten Einsatz eines chlorhexidinhaltigen Chips, lokaler Antibiotika , einer antimikrobiellen photodynamischen Therapie sowie einer Monotherapie mittels eines Er:YAG-Lasers oder eines modifizierten Pulverstrahlgeräts konnten dagegen die klinischen und mikrobiologischen Ergebnisse temporär verbessert werden [16] [17]. "
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    ABSTRACT: DENT IMPLANTOL 19, 5 332-337 (2015)
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    • "An abrasive air polishing medium can modify the surface of implants. After air powder treatment cell attachment and cell viability still showed sufficient levels, but cell response was decreased compared with sterile surfaces [64,65,67]. The extent of re-osseointegration of titanium implants after air polishing therapy has been reported between 39% and 46% with increased clinical implant attachment and pocket depth reduction [65]. "
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    ABSTRACT: Peri-implant inflammations represent serious diseases after dental implant treatment, which affect both the surrounding hard and soft tissue. Due to prevalence rates up to 56%, peri-implantitis can lead to the loss of the implant without multilateral prevention and therapy concepts. Specific continuous check-ups with evaluation and elimination of risk factors (e.g. smoking, systemic diseases and periodontitis) are effective precautions. In addition to aspects of osseointegration, type and structure of the implant surface are of importance. For the treatment of peri-implant disease various conservative and surgical approaches are available. Mucositis and moderate forms of peri-implantitis can obviously be treated effectively using conservative methods. These include the utilization of different manual ablations, laser-supported systems as well as photodynamic therapy, which may be extended by local or systemic antibiotics. It is possible to regain osseointegration. In cases with advanced peri-implantitis surgical therapies are more effective than conservative approaches. Depending on the configuration of the defects, resective surgery can be carried out for elimination of peri-implant lesions, whereas regenerative therapies may be applicable for defect filling. The cumulative interceptive supportive therapy (CIST) protocol serves as guidance for the treatment of the peri-implantitis. The aim of this review is to provide an overview about current data and to give advices regarding diagnosis, prevention and treatment of peri-implant disease for practitioners.
    Full-text · Article · Sep 2014 · Head & Face Medicine
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    • "Both treatment modalities were effective in reducing peri-implant infection and implants probing depths and in improving attachment levels with no intergroup differences. Similarly, Sahm and coworkers [22] in a clinical trial of nonsurgical treatment of peri-implantitis sites reported that implants' mean pocket reduction was 0.8 mm and attachment level gain was also 0.8 mm when using mechanical debridement and adjunctive subgingival irrigation with CHX solution and gel application into the pockets. Likewise, Renvert et al. [37] have used chlorhexidine gel in conjunction with mechanical debridement for the treatment of moderate pocket sites around dental implants. "
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    ABSTRACT: Peri-implant diseases are becoming a major health issue in dentistry. Despite the magnitude of this problem and the potential grave consequences, commonly acceptable treatment protocols are missing. Hence, the present paper reviews the literature treatment of peri-implantitis in order to explore their benefits and limitations. Treatment of peri-implantitis may include surgical and nonsurgical approaches, either individually or combined. Nonsurgical therapy is aimed at removing local irritants from the implants' surface with or without surface decontamination and possibly some additional adjunctive therapies agents or devices. Systemic antibiotics may also be incorporated. Surgical therapy is aimed at removing any residual subgingival deposits and additionally reducing the peri-implant pockets depth. This can be done alone or in conjunction with either osseous respective approach or regenerative approach. Finally, if all fails, explantation might be the best alternative in order to arrest the destruction of the osseous structure around the implant, thus preserving whatever is left in this site for future reconstruction. The available literature is still lacking with large heterogeneity in the clinical response thus suggesting possible underlying predisposing conditions that are not all clear to us. Therefore, at present time treatment of peri-implantitis should be considered possible but not necessarily predictable.
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