Abstract
ObjectivesTo 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 methodsThe 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).ResultsA 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.ConclusionsBacterial biofilm removal from infected implant surfaces was significantly superior for mechanical debridement than chemical decontamination.Clinical relevanceThe 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.
Highlights
Implant therapy is an effective and predictable method to replace missing teeth with high long-term success and survival rates
The study was designed as a single-blind, randomized, con- In all groups, treatment was performed by the same surgeon trolled, ex vivo investigation with intra-subject control to (G.L.M), experienced in the protocol of surface decontamination and reconstructive surgery of periimplantitis defects [10]
The semiquantitative microbiological analysis found mean values of 37,800.00 ± 46,837.05 CFU/ml for untreated implants, 531.58 ± 372.07 CFU/ml for implants treated with mechanical debridement, 29,650.00 ± 42,596.20 for implants treated with chemical decontamination, and 954.05 ± 2219.31 for implants treated with combined mechanical-chemical decontamination
Summary
Implant therapy is an effective and predictable method to replace missing teeth with high long-term success and survival rates. Biological complications, i.e., peri-implant mucositis and peri-implantitis, due to the local inflammatory reaction of marginal soft tissues to the biofilm may happen. Peri-implantitis is an increasing problem, with a wide range of the prevalence, ranging between 9.25 and 12.8% at the implant level, and between 17 and 22% at the patient level, due to differences in clinical case definitions [1,2,3]. Peri-implantitis is “a plaque-associated pathological condition, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone” [4]. As peri-implantitis is the effect of an infection process due to the formation of bacterial biofilm on implant surfaces, the target of treatments, either non-surgical or surgical, is to control bacterial infection and peri-implant inflammation. The goal is to stop the disease progression, which can gradually lead to implant loss, and to preserve healthy tissues around functioning implants
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