Regenerative surgical therapy for peri-implantitis using deproteinized bovine bone mineral with 10% collagen, enamel matrix derivative and Doxycycline-A prospective 3-year cohort study.

Abstract

There is limited evidence regarding the long-term efficacy of regenerative treatment for peri-implantitis. The aim of this study was to evaluate a combination therapy of deproteinized bovine bone mineral with 10% collagen (DBBMC), enamel matrix derivative (EMD) and Doxycycline in the regeneration of bone defects associated with peri-implantitis. Thirty patients diagnosed with peri-implantitis (BoP/suppuration, probing depth greater than 4mm, minimum radiographic bone loss of 20%, at least 2years in function) were enrolled in the study. Clinical measurements included probing depths, recession, radiographic bone fill, gingival inflammation and bleeding on probing/suppuration. Following surgical access and debridement, the implant surfaces were decontaminated with 24% EDTA for 2min, and the bone defects were filled with a combined mixture of DBBMC, EMD and Doxycycline powder. The defects were covered with connective tissue grafts where necessary. Clinical measurements were recorded after 12, 24 and 36months. The mean probing depth and bone loss at the initial visit was 8.9mm (±1.9) and 6.92mm (±1.26), respectively. Both mean probing depth and bone loss reduced significantly from baseline to 3.55mm (±0.50) and 2.85mm (±0.73) at 12months, 3.50 (±0.50) and 2.62mm (±0.80) at 24months and 3.50mm (±0.50) and 2.60mm (±0.73) at 36months. 56.6% of the implants were considered successfully treated (according to Successful Treatment Outcome Criterion: PD<5mm, no further bone loss >10%, no BoP/suppuration, no recession >0.5mm for anterior implants and >1.5mm for posterior implants) after 36months. Regenerative treatment of peri-implantitis using a combined mixture of DBBMC, EMD and Doxycycline achieved promising results. The benefits of this protocol incorporating EMD should be tested in randomized clinical trials.