Abstract
No proper treatment option for peri-implantitis exists yet. Based on previous studies showing the in vitro effectiveness of electrochemical disinfection using boron-doped diamond electrodes, novel double diamond electrodes (DDE) were tested here. Using a ceramic carrier and a laser structuring process, a clinically applicable electrode array was manufactured. Roughened metal discs (n = 24) made from Ti-Zr alloy were exposed to the oral cavities of six volunteers for 24 h in order to generate biofilm. Then, biofilm removal was carried out either using plastic curettes and chlorhexidine digluconate or electrochemical disinfection. In addition, dental implants were contaminated with ex vivo multispecies biofilm and disinfected using DDE treatment. Bacterial growth and the formation of biofilm polymer were determined as outcome measures. Chemo-mechanical treatment could not eliminate bacteria from roughened surfaces, while in most cases, a massive reduction of bacteria and biofilm polymer was observed following DDE treatment. Electrochemical disinfection was charge- and time-dependent and could also not reach complete disinfection in all instances. Implant threads had no negative effect on DDE treatment. Bacteria exhibit varying resistance to electrochemical disinfection with Bacillus subtilis, Neisseria sp., Rothia mucilaginosa, Staphylococcus haemolyticus, and Streptococcus mitis surviving 5 min of DDE application at 6 V. Electrochemical disinfection is promising but requires further optimization with respect to charge quantity and application time in order to achieve disinfection without harming host tissue.
Highlights
Peri-implantitis is currently understood as an inflammatory process affecting soft and hard tissues surrounding dental implants [1] and resulting in the destruction of alveolar bone and attachment [2].As such, peri-implantitis has to be differentiated from adaptation processes occurring as a result of surgical trauma and loading, leading to foreign body equilibrium [3].Potentially due to improper definition over a period of several years as well as the fact that several patient- and implant-related factors have to be considered clinically [1], the prevalence of peri-implantitis reported differs vastly among authors
These options range from mechanical debridement, e.g., using a titanium brush [11] followed by the application of chlorhexidine [12,13] or 35% phosphoric acid [14] to air powder treatment with sodium carbonate [15], which may be combined with local antibiotics or antiseptics [10]
While it may be argued that alternative treatment strategies such as air powder abrasion [15] may have been more appropriate as control, it has to be kept in mind that simple, flat surfaces were considered here, which could be well accessed
Summary
Peri-implantitis is currently understood as an inflammatory process affecting soft and hard tissues surrounding dental implants [1] and resulting in the destruction of alveolar bone and attachment [2]. Previous investigations using simplistic arrays of single electrodes have shown that electrochemical disinfection can effectively inactivate monospecies biofilm both during root canal treatment [32] and peri-implantitis treatment [33] without affecting surface characteristics, as may be the case with the use of curettes and airflow instruments [34]. Further developing this technology for clinical application, it was the goal of this study to fabricate and test a novel laser-structured, ceramic-based BDD electrode array for removing wild-type multispecies biofilm
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