Bone Level Gain Research Articles

Electrolytic Surface Decontamination in the Reconstructive Therapy of Peri-Implantitis: Single-Center Outcomes of a Randomized Controlled Trial.

Surface decontamination in the reconstructive therapy of peri-implantitis is of paramount importance to achieve favorable outcomes. The objective of this single-center study derived from a large multicenter clinical trial was to compare the electrolytic method (EM) used as an adjunct to mechanical decontamination, to hydrogen peroxide (HP) also used as an adjunct to mechanical decontamination, in the reconstructive therapy of peri-implantitis. At 12-month (T2) follow-up, 19 patients (Nimplants= 23) completed the study. None of the tested modalities demonstrated superiority in terms of the assessed clinical parameters. Only mucosal recession showed higher stability in the EM group. Alike, radiographic marginal bone level gain and defect angle changes at T2 did not differ between the evaluated strategies. Notably, disease resolution was ∼16% higher in the EM; however, differences did not reach statistical significance. Additionally, it was demonstrated that pocket depth and intra-bony component depth at baseline were predictors of disease resolution. In conclusion, the EM combined with mechanical instrumentation results in a safe and effective surface decontamination modality in the reconstructive therapy of peri-implantitis. This strategy resulted in ∼91% disease resolution rate.

ADJUNCTIVE ANTIBIOTICS MAY REDUCE PROBING DEPTH, INCREASE BONE LEVEL GAIN, AND CONTRIBUTE TO OVERALL SUCCESS IN PERI-IMPLANTITIS TREATMENT FOR UP TO 12 MONTHS POSTOPERATIVELY

Wang Y, Chen CY, Stathopoulou PG, Graham LK, Korostoff J, Chen YW. Efficacy of Antibiotics Used as an Adjunct in the Treatment of Peri-implant Mucositis and Peri-implantitis: A Systematic Review and Meta-analysis. Int J Oral Maxillofac Implants. 2022 Mar-Apr;37(2):235-249. doi:10.11607/jomi.9220. PMID: 35476853. None. Systematic review with meta-analysis of data.

Influence of periodontal susceptibility on the periodontal healing of adjacent second molars after surgical extraction of impacted mandibular third molar

Objective: To compare bone level changes and probing depths at the adjacent mandibular second molar (M2) 6 months after impacted mandibular third molar (M3) extraction between patients with and without periodontitis. Material and Methods: Patients referred for extraction of M3 were recruited. Patients were categorized as periodontally susceptible (PSP) or healthy patients (PHP). Six months after surgical extraction of M3 (T1), periodontal probing depths (PPD) and radiographic bone level at M2 were compared between the two groups. Regression analyses were performed to identify factors associated with PPD and bone level changes. Results: Forty-two patients completed the study, and the mean follow-up duration was 6.7 months. There was no significant difference in radiographic bone gain at M2 between PSP and PHP patients (1.26mm vs 1.13 mm). Every 1% increase in full mouth bleeding score at T1 was associated with 2.64mm less bone gain at M2. The PSP group was 6.43 times more likely to have PPD ≥ 5 mm at T1. Conclusions: Second molars in patients with periodontitis were not associated with less bone level gain 6 months after extraction of impacted M3. However, second molars in patients with higher gingival inflammation were associated with less bone gain.

Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2- to 7-year retrospective study.

Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth. Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento-implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre-orthodontic extrusion (T0 ), post-orthodontic extrusion and retention (T1 ), and latest follow-up (T2 ). A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow-up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento-implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento-implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group. Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid-term stable proximal bone and papilla adjacent to maxillary anterior single implants. This retrospective study presents a mid-term result on orthodontic extrusion as a mean to regenerate dento-implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain.

A Systematic Review and Meta-Analysis of the Clinical Outcomes for Adjunctive Physical, Chemical, and Biological Treatment of Dental Implants With Peri-Implantitis.

The present systematic review evaluated the efficacy of adjunctive therapies in the treatment of peri-implantitis. Studies comparing the outcome of conventional surgical- or nonsurgical mechanical debridement with the addition of an adjunctive therapeutic modality were identified through an electronic and hand search of available literature. Following data extraction, meta-analyses were performed on the primary outcome measures. The effects of the adjunctive therapies on bleeding on probing (13 studies), probing pocket depth (9 studies), and radiographic bone level changes (7 studies) were analyzed to evaluate potential clinical benefit. Heterogeneity was expressed as the I2 index. Fixed and random effect models were demonstrated. The potential benefit of adjunctive therapies over control procedures was evaluated in 18 studies, representing a total of 773 implants. Quality assessment of the studies found only 3 studies to be at a low risk of bias. Meta-analysis among the different additional modalities revealed chemical therapy demonstrating significant effects in probing pocket depth reduction (0.58 mm; 0.44-0.72) and radiographic bone level gain (0.54 mm; 0.16-0.92). No significant improvements in bleeding on probing reduction were found using any adjunctive therapy. Available evidence on the benefits of adjunctive therapy to nonsurgical or surgical mechanical debridement in the treatment of peri-implantitis is limited by low numbers of standardized, controlled studies for individual therapies, heterogeneity between studies, and a variety of outcome measures. The lack of effect of any adjunctive therapy in reducing bleeding on probing questions the overall effectiveness over conventional treatment. The long-term clinical benefit potential of these therapies is not demonstrated.

Efficacy of access flap and pocket elimination procedures in the management of peri-implantitis: A systematic review and meta-analysis.

To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri-implantitis. Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri-implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta-analysis and meta-regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). Evidence from studies directly comparing surgical with non-surgical therapy is lacking. Based on pre-post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8-2.7) and BOP% (27.0; 95% CI 19.8-34.2) as well as marginal bone level gain (0.2 mm; 95% CI -0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5-0.9) for every millimetre in increase of mean PD at baseline. During the follow-up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. Access flap and pocket elimination surgery are effective procedures in the management of peri-implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions.

A comparative evaluation of lasers and photodynamic therapy in the nonsurgical treatment of peri-implant diseases: A Bayesian network meta-analysis

PurposeWe conducted this Bayesian network meta-analysis (NMA) to evaluate the safety and efficacy of different lasers and PDT compared to conventional mechanical debridement (CMD) for peri-implant treatment. MethodsThe Web of Science, Cochrane Library and PubMed databases were searched for randomized clinical trials (RCTs) assessing the clinical effectiveness of adjunctive PDT, different lasers, and CMD until January 1st, 2022. Clinical outcomes were the changes in pocket probing depth (PPD), marginal bone loss (MBL), and clinical attachment level (CAL). ResultsTwenty-three studies, including 4 types of lasers, were included. Compared to that with CMD alone, PPD reduction was significantly more efficient in the diode laser (LD)+CMD groups (MD, 0.53; 95%CI, 0.13–0.93) and the PDT+CMD groups (MD, 0.83; 95%CI, 0.32–1.34) than in the CMD group in the follow-up period. Moreover, PDT+CMD treatment also showed a significantly better marginal bone level gain (MD, 0.32; 95%CI, 0.06–0.57). No significant effect on ΔCAL was observed among the different treatment strategies. Despite no differences in PPD reduction, MBL and CAL gains were found among the adjunctive laser treatment groups, PDT+CMD had the highest ranking probability of the most effective treatment in these clinical indices of periodontitis. The certainty of evidence for all outcomes was judged as very low to moderate. ConclusionsWithin the limits of this NMA, we found that adjunctive PDT achieved a small additional benefit on PPD reduction and MBL gain compared with CMD alone and had the highest probability of being ranked first on the changes in PPD, MBL and CAL. PDT+CMD may represent an alternative method for peri‑implant treatment. Further high-quality RCTs are needed to assess the influence of potential confounders on the efficacy of lasers and PDT.

Combined Regenerative and Mucogingival Treatment of Intraosseous Defects with Buccal Gingival Recession: A Case Series

<p>Abstract: Regenerative surgery is an effective treatment of intraosseous defects, however, subject with thin gingival tissue phenotype and bone dehiscence defect tends to have more post-surgery gingival recession. The gingival recession is considered as soft tissue loss, which may affect the result of periodontal regeneration. Therefore, this case series aimed to describe a periodontal regenerative surgery combined with subepithelial connective tissue graft (SCTG) in intraosseous defects associated with buccal gingival recession would make periodontal regeneration more predictable. Materials and Methods: The case series describes a surgical approach to improve regenerative parameters in deep intraosseous defects associated with buccal gingival recession. Teeth with buccal bone dehiscence or furcation involvement were included. The surgical technique consisted of an SCTG placed on the buccal dehiscence defect or furcation area to thicken the soft tissue wall, then treated with enamel matrix derivative and biomaterials as regenerative scaffolds inside the intraosseous component of the defect. Results: In all cases, there were buccal gingival margin thickness increased, significant clinical attachment level gain, bone level gain, reduced probing pocket depth, and partial root coverage at least one year after the surgery. The radiographs demonstrated increased bone density of the deep intraosseous defects associated with buccal gingival recession in both single root and furcation-involved teeth. Conclusion: The combination of regenerative treatment and SCTG in intraosseous defects associated with buccal gingival recession in a single root or furcation-involved molar supports the stability of the gingival profile and improves root coverage outcome as well as periodontal regeneration.</p> <p> </p>

Efficacy of Antibiotics Used as an Adjunct in the Treatment of Peri-implant Mucositis and Peri-implantitis: A Systematic Review and Meta-analysis.

This systematic review aimed to assess the clinical efficacy of antibiotics when used as an adjunct in treating peri-implant diseases. A systematic search of papers published between January 1980 and March 2020 was conducted. Randomized clinical trials with at least 10 patients who had peri-implant diseases, treated with or without adjunctive antibiotics in combination with surgical or nonsurgical therapies, and with a minimum of at least 3 months of follow-up were included. Meta-analyses were conducted to analyze weighted mean differences in probing depth reduction, radiographic bone level gain, and odds ratio of treatment success. From the 856 articles identified, 10 articles met the inclusion criteria and were selected. Of these, 7 articles were used for the meta-analysis. The adjunctive use of antibiotics in the treatment of peri-implant diseases yielded significantly greater probing depth reduction (weighted mean differences = 0.56 mm at 3 months, P = .001; 0.77 mm at 6 months, P < .00001; 0.92 mm at 12 months, P < .00001), radiographic bone level gain (weighted mean differences = 0.64 mm, P = .03), and treatment success (odds ratio = 1.74, P = .04) compared to the same treatment without antibiotics. Based on the existing evidence, the use of adjunctive antibiotics to treat peri-implant diseases, especially peri-implantitis, provided potential benefits in clinical outcomes for up to 12 months posttherapy.

Surgical Regenerative Treatment in Combination with Magnetic Laser Supportive Therapy of Peri-Implantitis

Objective: The objective this study is to evaluate the potential of magnetic-lazer therapy as a supportive treatment of peri-implantitis. Materials and Methods: The 34 patients suffering from Peri-Implantitis were selected for this study. The patients randomly divided into two groups; 18 patients first group received surgical conventional treatment,16 patients second group received surgical conventional treatment and magnetic-lazer application. A total of 46 implants were treated with moderate peri-implantitis. Diagnostic parameters used to evaluate peri-implantitis include clinical indicators, Probing Pocket Depth (PPD), Bleeding On Probing (BOP), Marginal Bone Level (MBL) suppuration, mobility. Clinical and radiographical parameters were recorded before treatment (baseline) and at 3, 6 and 12, 36 months after therapy. Results: Reduction PPD and BOP was observed in comparison with basic clinical measurements. The mean BOP in 34 patients before treatment of peri-implantitis was 2.5 ± 0.31, after treatment, the first group of patients had mean 0.6 ± 0.1, the second group had mean 0.4 ± 0.12. The mean PPD in patients before treatment of peri-implantitis was 5,2±0,24, after treatment, the first group of patients had mean 3,9±0,28, the second group had mean 3,2±0,17. The mean MBL concomitant bone level gain averaged was 1, 54 mm in first group and 2.35 mm in second group. Stable clinical measurements PPD and BOP were demonstrated during the following 1,3 years. Conclusion: Surgical regenerative treatment combined with magnetic-laser supportive therapy reliable method for treatment peri-implantitis and may be considered an adjunct to the conventional surgical treatments of peri-implantitis

Evaluation of biphasic hydroxapatite and β-tricalcium phosphate as a bone graft material in the treatment of periodontal vertical bony defects - A clinical and digital radiological measurement study.

The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and β-tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and β-tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Overall, by the end of 6 months, biphasic hydroxyapatite and β-tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow-up. In the biphasic hydroxyapatite and β-tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. In the present study, biphasic hydroxyapatite and β-tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.

The impact of supportive periodontal treatment on the outcome of regenerative surgical therapy in aggressive periodontitis patients.

Objective: The aim was to evaluate the efficacy of periodontal regenerative therapy using enamel matrix derivatives (EMDs) in aggressive periodontitis patients, and to determine the contribution of maintenance via periodic supportive periodontal treatment. Method and materials: In total, 28 patients were evaluated, comprising 74 intrabony sites. In 50 sites EMD gel was applied, and in 24 sites EMD was combined with deproteinized bovine xenograft. Patients were assigned to a supportive periodontal treatment program; 18 patients fulfilled the program, defined as the well-maintained (WM) group; 10 did not comply, defined as the nonmaintained (NM) group. Probing depth (PD), clinical attachment level (CAL), and radiographic bone level (BL) were recorded. Data were compared presurgically (T0), 6 months postsurgery (T1), and 3 to 10 years posttreatment (T2). Results: Both surgical modalities achieved similar PD reduction, CAL gain, and BL gain, maintained over time. T1 to T2 showed a mean gain/loss of 0.21 ± 0.5 mm and 0.04 ± 1.1 mm, and -0.65 ± 3.0 mm and -0.73 ± 3.0 mm for PD and CAL, respectively, at the WM/NM groups, respectively. BL gain was 21.6% and 11.5% for the WM/NM groups, respectively (P < .05). The courses of the PD, CAL, and BL differed between the WM and NM groups during the observation periods (P < .05). Conclusion: Periodontal regeneration via EMD with/without the combination of deproteinized bovine xenograft can be maintained in aggressive periodontitis cases. It appears that periodic supportive periodontal treatment is a determinant factor in achieving this task.

Single-flap versus double-flap approach for periodontal pocket reduction in supraosseous defects: a comparative study.

PurposeThe single-flap approach (SFA) is a minimally invasive technique with limited mucoperiosteal flap elevation to gain access to the buccal/palatal aspects, thus limiting post-surgical complications. The purpose of the present study was to gain insights into the impact of the SFA over the double-flap approach (DFA) on periodontal flap treatment outcomes and patient compliance in terms of discomfort and time taken for surgical procedures.MethodsTwenty patients with persistent probing pocket depths of ≥5 mm were scheduled for the SFA (test site) and for the DFA (control site). All the clinical periodontal parameters were recorded at baseline, 3 months, and 6 months. Radiographic bone level (cone-beam computed tomography) was evaluated at baseline and 6 months. Patients' postoperative pain perception and wound healing were also assessed.ResultsThe SFA showed a significant reduction in periodontal pocket depth, gain in clinical attachment level (CAL), and gain in bone level when compared with the DFA. The SFA substantially improved wound healing and induced less postoperative pain than the DFA.ConclusionsThe SFA resulted in substantial improvement in the composite outcome measures, as shown by a reduction in pocket depth with minimal gingival recession, gain in CAL, early wound healing, less postoperative discomfort, and better patient-centered outcomes.Trial RegistrationClinical Trials Registry-India Identifier: CTRI/2018/05/013562

Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: A single-center, open-label trial.

Aims:The aim of this study was to compare outcomes of lateral osteoperiosteal flap (OPF) and lateral pedicle flap (LPF) in the treatment of Miller's Class III gingival recession.Materials and Methods:Twenty-two anterior maxillary and mandibular sites from 16 participants requiring mucogingival surgery for Miller's Class III gingival recession were included in the study. Eleven sites each were assigned to two groups. OPF: sites treated with lateral OPF and LPF: sites treated with LPF. Recession depth (RD) and bone level (BL) were the primary outcome variables, and probing pocket depth, clinical attachment level (CAL), and keratinized tissue width (KTW) were the secondary variables. All the variables were recorded at baseline (on the day of surgery), 3 months, and 6 months postsurgery.Results:OPF and LPF resulted in similar reduction in RD at the end of the study period (P ≤ 0.001). There was no statistically significant difference in RD between OPF and LPF at 6 months (P = 0.862). OPF-treated sites showed greater gain in BL at 3 months (P = 0.0004) and 6 months (P = 0.0002). No significant differences were seen between OPF and LPF in measures of PD, CAL, and KTW.Conclusion:Data from this 6-month trial seem to suggest that OPF can be used as an alternative procedure for treating Miller's class III recessions with adjacent edentulous sites or wide interproximal spaces. Long-term effects of OPF on the stability of root coverage outcomes are an exciting direction for future research.

Re‐osseointegration following reconstructive surgical therapy of experimental peri‐implantitis. A pre‐clinical in vivo study

To evaluate the effect of bone substitute materials on hard and soft tissue healing in reconstructive surgical therapy of experimental peri-implantitis at implants with different surface characteristics. Six female, Labrador dogs were used. 3months after tooth extraction, four implants with two different surface characteristics (A and B) were installed on each side of the mandible. Experimental peri-implantitis was induced 3months later. During surgical treatment of peri-implantitis, the implants were cleaned with curettes and cotton pellets soaked in saline. The implant sites were allocated to one of four treatment categories; (a) Group C; no augmentation, (b) Group T1; bone defect filled with deproteinized bovine bone mineral (c) Group T2; bone defect filled with a biphasic bone graft material, (d) Group T3; bone defect filled as T1 and covered with a collagen membrane. Clinical and radiological examinations were performed, and biopsies were obtained and prepared for histological analysis 6months after peri-implantitis surgery. Implant B (smooth surface) sites showed significantly (a) larger radiographic bone level gain, (b) enhanced resolution of peri-implantitis lesions, and (c) larger frequency of re-osseointegration than implant A (moderately rough surface) sites. Implant B sites also showed superior preservation of the mucosal margin. Differences between bone substitute materials and control procedures were overall small with limited advantages for T1 and T2 sites. Healing following reconstructive surgical treatment of experimental peri-implantitis was superior around implants with a smooth surface than implants with a moderately rough surface. Benefits of using bone substitute materials during surgical therapy were overall small.

Use of TiBrush for surface decontamination at peri-implantitis sites in dogs: Radiographic and histological outcomes.

The aim of the present study was to evaluate the efficacy on the healing of mechanical decontamination of infected implant surfaces performed with a titanium brush. Mandibular premolars and first molars were extracted bilaterally in six dogs. After 3months, two unsubmerged implants were installed on both sides of the mandible. Three months later, peri-implantitis was induced with ligatures for 3months and then removed. After 1month, surgical mechanical decontamination of the surfaces was performed either with a rotatory titanium brush or gauzes soaked in saline. Five month later, biopsies were retrieved. Evaluations on X-rays taken of the mesiodistal plane and on histological slides prepared in a buccal-lingual plane were performed. After the induction of peri-implantitis, a mean marginal bone loss of 2.6±0.6mm and 1.9±1.0mm was observed in the brush and gauze groups by X-ray, respectively. Five months after treatment, a mean gain of marginal bone of 0.6mm was obtained in both groups. The mean closures of the vertical and horizontal defects were 0.6mm and 0.6mm for the brush group, and 0.8mm and 0.5mm for the gauze group, respectively. Histologically, a loss of attachment at the buccal aspect of 2.2±0.9mm in the brush group and of 2.3±0.5mm in the gauze group was found. No statistically-significant differences were found after the treatment. Mechanical implant surface decontamination performed with a rotatory titanium brush resulted in a marginal bone level gain, yielding a low content of inflammatory infiltrate close to the marginal bone.

Single-Tooth Implant Restorations in Fresh Extraction Sockets of the Maxillary Esthetic Zone: Two-Year Results of a Prospective Cohort Study.

In this prospective study, 15 patients received 15 variable-thread tapered implants placed in fresh extraction sites in the maxillary esthetic zone and immediately were provisionalized out of occlusion. Of the 15 patients, 11 completed their 2-year follow-up. At 2 years, the success and cumulative survival rates were both 100%, and the mean bone level gain was 0.83 mm. Soft tissue assessment showed no zero esthetic scores, improved papilla indices, and low bleeding on probing and plaque accumulation. Overall, the study implants showed excellent hard tissue, soft tissue, and esthetic outcomes, indicating a healthy tissue response in single-tooth extraction sites in the maxillary esthetic zone.

Comparative clinicoradiographical evaluation of effect of aminobisphosphonate (sodium alendronate) on peri-implant bone status: Controlled clinical trial.

Aim:The present study aims to compare the peri-implant bone status around immediately loaded dental implants treated with aminobisphosphonate solution and untreated control implants in terms of clinical and radiographical parameters.Materials and Methods:A total of 24 patients were randomly divided equally into two groups. This study was conducted in accordance to the Helsinki's declaration of 1975, revised in 2000, and with the approval of the institutional ethical committee. In the control group after preparation, osteotomy sites were irrigated with normal saline solution, whereas in the test group osteotomy sites were irrigated with modified bisphosphonate solution and then TRX-OP, Hi-Tec dental implants were inserted. Clinical parameters, such as modified plaque and gingival index, probing depth, mobility, and radiographic parameters were recorded at baseline (0), 3, 6, and 9 months. Data analysis was performed using the Statistical Package for the Social Sciences version 17 for windows, and the statistical techniques employed were repeated measures analysis of variance, independent sample t-test, and paired sample t-test.Results:Reduction in mean radiographic bone levels (height) was observed on the mesial and distal aspect of the control group in comparison to its baseline at all intervals. In the test group, there was reduction in mean radiographic bone levels on mesial and distal aspect of the implant site in comparison to its baseline till 6-month follow up, however, at 9 month, there was gain in bone level on both mesial and distal aspect of implant. This represents the effectiveness of sodium alendronate in enhancing the bone formation. On comparison, between both groups on mesial and distal aspect of implants, statistically significant differences were observed at 3 and 9 months on mesial and distal aspect, respectively, without any clinical evidence of mobility in the test group.Conclusion:Implant site treated with aminobisphosphonate solution represents greater efficacy in enhancing bone formation when used as an irrigant; thus, it is considered beneficial in implant dentistry.

A Regenerative Approach to the Successful Treatment of Peri-implantitis: A Consecutive Series of 170 Implants in 100 Patients with 2- to 10-Year Follow-up.

This article presents the results of a consecutive case series of 170 treated peri-implantitis-affected implants in 100 patients with follow-up measurements from 2 to 10 years. A total of 51 implants in 38 patients previously reported on were followed for an additional 2.5 years, and 119 additional implants in 62 additional patients were treated with the same protocol and monitored for at least 2 years posttreatment. The treatment consisted of flap reflection, surface decontamination, use of enamel matrix derivative (EMD) or platelet-derived growth factor (PDGF), and guided bone regeneration with mineralized freezedried bone and/or anorganic bovine bone combined with PDGF or EMD and covered with an absorbable membrane and/or subepithelial connective tissue graft. Maintenance and monitoring followed every 2 to 3 months. Two implants were lost 6 months posttreatment, for a 98.8% survival rate. Bleeding on probing was eliminated in 91% of the treated implants. Probing depth reduction averaged 5.10 mm, bone level gain averaged 1.77 mm, and soft tissue marginal gain averaged 0.52 mm. These outcomes were obtained with one surgical procedure on 140 implants, with two procedures on 18 implants, and with three procedures on 10 implants. The results to date with this layered/combined regenerative approach for the treatment of peri-implantitis appear to be encouraging.

Regenerative Treatment for a Peri‐Implantitis‐Affected Implant: A Case Report

Introduction: Peri‐implantitis is an inflammatory disease in the mucosa around an implant that results in bone loss and, if allowed to progress, can result in loss of the implant. This disease has been estimated to have a prevalence varying from 11.3% to 56%. To date, there is little evidence to indicate the most effective method of treatment of peri‐implantitis. This report describes a regenerative treatment for restoration of bone and reduction of probing depth (PD) around a peri‐implantitis‐affected implant.Case Presentation: A 67‐year‐old male patient presented with advanced peri‐implantitis around a mandibular right first molar implant that was placed and restored 3 years before his visit. An examination revealed PD of 7 to 12 mm and bone loss of 7 to 10 mm circumferentially around the implant. Treatment consisted of flap reflection, a six‐step surface decontamination, placement of enamel matrix derivative on the implant surface, and fill of the defect with combined allograft/xenografts mixed with platelet‐derived growth factor. The graft was covered with two absorbable collagen membranes, and the flap was coronally advanced and sutured. A 7‐year follow‐up revealed PD reduction of 4 to 10 mm, bone level gain of 3 to 3.5 mm, and no change in the coronal level of the mucosa (no post‐surgical recession).Conclusion: The technique used in this case report resulted in an outcome that saved the implant, brought the peri‐implant tissues back to health, and reduced PD and increased bone support around the affected implant without soft‐tissue recession.