Management Of Peri-implantitis Research Articles

The efficacy of reconstructive therapy in the surgical management of peri-implantitis: A 3-year follow-up of a randomized clinical trial.

To assess whether guided bone regeneration (GBR) treatment of peri-implantitis-related bony defects could improve healing compared to open flap debridement (OFD) at 36 months. In a multi-centre, randomized clinical trial, 32 individuals received OFD (control group [CG]) and 34 GBR treatment (test group [TG]). Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP) suppuration (SUP), mucosal recession (MREC) and patient-reported outcomes (PROs) were evaluated at 36 months. Fifty individuals attended a supportive peri-implant therapy program and completed the 36-month follow-up. GBR treatment resulted in an RDF of 2.13 ± 1.26 mm compared to 1.64 ± 1.54 mm following OFD (p = .18). No difference was found in PPD, BOP, SUP, REC or PROs between the groups. Successful treatment (no additional bone loss, PPD ≤ 5 mm, no BOP and no SUP) was achieved in 46.2% in TG and 20% in CG (p = .053). Treatment results obtained at 12 months were generally maintained up to 36 months. No significant changes were noticed between 12 and 36 months. At 36 months, treatment results obtained at 1 year were sustained following both GBR and OFD in patients attending supportive peri-implant therapy. GBR resulted in more RDF and higher composite treatment success rate than OFD (ClinicalTrials.gov Identifier [NCT02375750]).

Advancements in dental implant technology: the impact of smart polymers utilized through 3D printing

The field of dental implantology has witnessed significant advancements in recent years, driven by innovations in materials science and manufacturing technologies. One such innovation that holds promise for revolutionizing dental implant generation is the mixing of smart polymers thru three-D printing. This evaluation article affords a comprehensive overview of the effect of clever polymers in enhancing the performance and functionality of dental implants. We begin by using elucidating the fundamental residences of smart polymers, which include their stimuli-responsive conduct, biocompatibility, and mechanical strength. sooner or later, we discover the evolution and programs of 3ِD printing, e.g. like direct metallic laser sintering (DMLS) and selective laser melting (SLM), in dentistry, highlighting its position in fabricating custom designed dental implants. the combination of smart polymers into dental implants is discussed in element, overlaying surface modification techniques, incorporation of bioactive dealers, and customization for affected person-particular desires. furthermore, we look at how smart polymers make contributions to enhancing aspects such as osseointegration, peri-implantitis management, and average implant toughness. clinical insights and case studies are presented to illustrate the real-global applications and results of clever polymer-based dental implants. ultimately, this evaluation objectives to offer valuable insights for clinicians, researchers, and industry specialists worried within the improvement and utilization of advanced dental implant technologies.

Surgical treatment of peri-implantitis

As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.

Peri-implantitis: Knowledge and attitudes of implantology clinicians regarding the disease management: Peri-implantitis knowledge.

Since peri-implantitis is an increasing and prevalent concern in clinical practice and there is no consensus regarding the best therapeutic protocol, this study evaluated the knowledge and behaviours of dentists working in Implantology regarding implant-related infections modulating factors and therapeutic protocols used in the management of peri-implantitis. Cross-sectional study was conducted with 86 Brazilian Implantology clinicians. Data were collected using a structured and online questionnaire evaluating socioeconomic characteristics, education, work/clinical practice, knowledge and attitudes regarding the risk factors and management of peri-implantitis. The reliability of the questionnaire was evaluated by test-retest technique. The questionnaire was developed based on the last consensus on peri-implant diseases (2018) and the current evidence related to implant-related infections. Descriptive, bivariate and logistic regression analyses were conducted adopting a significance level of 5%. In this study, 89.5% of included dentists reported that already treated patients with peri-implantitis. Approximately 80% of dentists use antibiotics and mouth rinses during the treatment, and surgical procedures seem the main choice to treat peri-implantitis (91.8%) by dentists. As a preventive approach, 94.2% of dentists reported that routinely assessedbiofilm accumulation in the follow-up visits after implant placement. Logistic regression showed that the self-reported ability to treat peri-implantitis was statistically (p < 0.05) higher among dentists who reported abilities to diagnose the disease and use laser for peri-implantitis treatment. Dentists working in Implantology have a good level of knowledge and behaviors in the management of peri-implantitis. However, the lack of consensus regarding the best treatment protocols may reflect dentist's behaviours because different treatment protocols have been used by evaluated clinicians.

Clinical and Biochemical Evaluation of Chlorohexidine Gel Versus Propolis Gel in Non-Surgical Management of Peri-Implantitis (Randomized clinical trial)

Clinical and Biochemical Evaluation of Chlorohexidine Gel Versus Propolis Gel in Non-Surgical Management of Peri-Implantitis (Randomized clinical trial)

Management of peri-implantitis using local drug delivery among Indian patients.

It is of interest to compare 0.2% chlorhexidine gel, 0.2% chlorhexidine chip, minocycline microspheres and slow-release doxycycline gel and tetracycline fibers as drug delivery systems in the management of peri-implantitis. The study comprised of 105 Indian participants who had a minimum of one dental implant with a probing depth of 4 mm, along with exudate and/or bleeding upon probing along with the presence of potentially harmful germs. The use of minocycline microspheres and 0.2% chlorhexidine gel resulted in significant improvements in probing depths at 1 month, 3 months and 6 months and all treatments showed decline in the indicator bacteria. Thus, minocycline microspheres and 0.2% chlorhexidine gel is useful as an adjuvant for mechanical debridement in management of peri-implantitis.

Clinical and radiographic outcomes of a combined surgery approach to treat peri-implantitis

Peri-implant infra-bony defects are difficult to treat, and data on the management of peri-implantitis are lacking. The aim of this study was to evaluate the effect of a combined surgical approach to manage peri-implantitis: implantoplasty with xenogeneic bone grafting and a concentrated growth factor membrane. Two independent examiners analysed the medical records and radiographs taken before surgery and at the last follow-up. Data were analysed at the implant level; some patient-level data (age, sex, smoking habit) were also considered. Linear regression analysis with generalized estimating equations (GEE) was used to explore the effect of variables of interest (including marginal bone level (MBL)) on implantitis treatment success and resolution rates. The effect of the prosthesis type on postoperative clinical and radiographic parameters was also explored by GEE, with adjustment for age, sex, tooth site, location, follow-up duration, and implant length (model IV including all). Thirty patients with 72 implants were investigated. The implant survival rate was 100% over a mean observation period of 3.3 years (range 2–11 years). The treatment success rate (bone loss <0.5 mm, no bleeding on probing (BOP), no suppuration, probing depth (PD) < 5 mm) was higher in females than males (50% vs 19.0%; P = 0.008). At the last postoperative follow-up, the MBL (1.51 ± 1.07 vs 4.01 ± 1.13 mm), PD (3.61 ± 0.84 vs 6.54 ± 1.01 mm), and BOP (23.38 ± 23.18% vs 79.17 ± 15.51%) were significantly reduced when compared to pre-surgery values (all P < 0.001). Furthermore, a significantly higher PD reduction (β = −1.10 mm, 95% confidence interval −1.97 to −0.23 mm, P = 0.014) was observed for implants with a single crown than a full-arch prosthesis (GEE model IV). Preliminary clinical and radiographic data indicate that implantoplasty in combination with surgery could be an effective treatment option for peri-implantitis.

Treatment of peri-implantitis: Fiction or reality? Part 2: Adjuncts and decontamination approaches in the non-surgical and surgical management of peri-implantitis

Treatment of peri-implantitis: Fiction or reality? Part 2: Adjuncts and decontamination approaches in the non-surgical and surgical management of peri-implantitis

Efficacy of phthalocyanine dye in antimicrobial debridement by photodynamic therapy as an adjunct to mechanical management of peri-implantitis: an in vitro study

Objective: The aim of the present in vitro study was to evaluate the efficacy of phthalocyanine dye in photodynamic therapy (PDT) as an adjunct to mechanical debridement in the management of peri-implantitis. Methods: S. aureus, F. nucleatum, and P. gingivalis were coated on titanium (Ti) discs and divided into control and test groups. In the control group, mechanical debridement + laser was performed, while in the test group, PDT with hydroxyaluminium phthalocyanine (AIPcOH) dye as photosensitizer was used. Bacterial colony counts and surface hardness were assessed post-operatively. Results: There was a significant difference in the bacterial count reduction at different time intervals in the test group (p=0.01) compared to the control group; no significant difference was observed in surface hardness (p=0.7). Conclusion: This present in vitro study concluded that PDT with AIPcOH dye was effective in eradicating S. aureus, F. nucleatum, and P. gingivalis on Ti discs. This study also concluded that PDT with a photosensitizer can be used as an adjunct in the management of peri-implantitis.

Emerging factors affecting peri-implant bone metabolism.

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.

Knowledge and attitude of dental students regarding etiology, diagnosis, and treatment of peri-implantitis.

The objective of this study was to assess the level of knowledge and attitude of dental students about the etiology, diagnosis, and management of peri-implantitis. An online cross-sectional study that targeted senior undergraduate dental students at the College of Dentistry was conducted. A closed-ended survey consisting of 28 questions was designed. Three sections were created: 1) participants' characteristics; 2) Knowledge of peri-implantitis etiology, risk factors, diagnosis, and complications; 3) The use of antibiotics in peri-implantitis, diagnosis, and treatment methods. SPSS version 22 (IBM Corp.) was used for data analysis. Counts and percentages were calculated for correct answers in each section. A total of 267 dental students responded to the questionnaire. The majority of the participants (81.6%) were knowledgeable about peri-implantitis being an inflammatory reaction, and a lesser percentage (77.9%) knew that bacterial plaque is an etiologic factor for peri-implant diseases. 82.0% of the participants identified smoking as a risk factor, followed by periodontitis (80.5%). Regarding implant complications, 57.3% of the participants considered implant mobility as a definitive indication for implant removal. More than half of the participants reported using crater-like bone defects surrounding implants to diagnose peri-implantitis. The most commonly used antibiotic was amoxicillin (34.1%), followed by amoxicillin combined with metronidazole (26.9%). Most participants had a basic understanding of the etiology and risk factors of peri-implantitis. On the other hand, more courses addressing peri-implantitis diagnosis are needed.

Photothermal-promoted multi-functional gallic acid grafted chitosan hydrogel containing tannic acid miniaturized particles for peri-implantitis

Peri-implantitis, a leading cause of implant failure, currently lacks effective therapeutic strategies. Given that bacterial infection and reactive oxygen species overabundance serve as primary pathogenic and triggering factors, respectively, an adhesive hydrogel has been created for in-situ injection. The hydrogel is a gallic acid-grafted chitosan (CS-GA) hydrogel containing tannic acid miniaturized particles (TAMP). This provides antibacterial and antioxidant properties. Therefore, this study aims to evaluate the potential role of this hydrogel in preventing and treating peri-implantitis via several experiments. It undergoes rapid formation within a span of over 20 s via an oxidative crosslinking reaction catalyzed by horseradish peroxidase and hydrogen peroxide, demonstrating robust adhesion, superior cell compatibility, and a sealing effect. Furthermore, the incorporation of TAMP offer photothermal properties to the hydrogel, enabling it to enhance the viability, migration, and antioxidant activity of co-cultured human gingival fibroblasts when subjected 0.5 W/cm2 808 nm near-infrared (NIR) irradiation. At higher irradiation power, the hydrogel exhibits progressive improvements in its antibacterial efficacy against Porphyromonas gingivalis and Fusobacterium nucleatum. It attains rates of 83.11 ± 5.42 % and 83.48 ± 6.855 %, respectively, under 1 W/cm2 NIR irradiation. In summary, the NIR-controlled CS-GA/TAMP hydrogel, exhibiting antibacterial and antioxidant properties, represents a promising approach for the prophylaxis and management of peri-implantitis.

Treatment of Peri-implantitis: Fiction or Reality? Part 1: Non-surgical and Surgical Management

Peri-implantitis is a biological complication characterized by an inflammatory process affecting the soft and hard tissues around an osseo-integrated load-bearing implant. Clinically, it results in progressive bone loss, pocket formation, bleeding and/or suppuration and leads to implant loss. Although the main aetiological factor is bacterial biofilms, the clinical presentation and progression of peri-implantitis is exacerbated by several local, systemic and iatrogenic factors. Treatment protocols of peri-implantitis include various decontamination procedures of the exposed implant surface. In this two-part series, we will review the available evidence for the non-surgical and surgical management of peri-implantitis (Part 1), and then we will discuss various modalities for implant surface decontamination (Part 2). CPD/Clinical Relevance: The pre-operative risk identification and management at both patient and site level, early diagnosis and regular supportive peri-implant care are fundamental for long term implant success and survival.

Prosthetic management of peri-implantitis: Analyzing risk factors and advancing preventive strategies

Dental implantology has transformed restorative dentistry by providing effective solutions for tooth replacement. However, challenges like peri-implantitis, involving inflammation and bone loss around dental implants, have emerged. This article explores the prosthetic management of peri-implantitis, emphasizing risk analysis and preventive strategies. Peri-implantitis's definition, clinical signs, and causes are outlined, encompassing local and systemic risk factors. Prosthodontists play a key role in removing prosthetic components, enabling thorough treatment. Mechanical and chemical methods for implant surface debridement are highlighted, focusing on infection removal and tissue healing. Preventive measures, such as patient evaluation, hygiene education, and treatment planning, are crucial for pre- and post-implant placement. Structured maintenance schedules, interdisciplinary collaboration, and customized prosthetic designs are pivotal in preventing recurrence. This comprehensive approach ensures implant longevity and elevates implant dentistry standards.

Surgical management of peri-implantitis in adjunction with BlueM oxygen therapy: a case report with 5-years follow-up

Peri-implantitis is an inflammatory disease associated with plaque accumulation in peri-implant tissues, and can cause implant failure. Several surgical and nonsurgical protocols have been proposed to treat patients with peri-implantitis. In this case report, we describe the surgical management of peri-implantitis with the use of BlueM oxygen therapy after mechanical debridement of dental implant surface. Although, several conventional anti-infective modalities have been employed to treat peri-implantitis, the application of topical oxygen therapy can be very effective. The case demonstrated good results with the maintenance of peri-implant bone level and absence of clinical signs of inflammation.

Role of Keratinized Tissue on the Management of Peri-implantitis: A Case Report.

Peri-implantitis is an inflammatory condition that involves the loss of attachment and support around dental implants. In this case report, a middle-aged woman presented with two implants in the mandibular right quadrant that were diagnosed with peri-implantitis. The patient also had tenderness around the implants and reported sensitivity when performing oral hygiene procedures. Surgical treatment comprised a free gingival graft to augment the keratinized tissue width around the implants, followed by a second procedure of implantoplasty and surface decontamination. The outcome showed radiographic resolution of the peri-implant defect around the premolar implant with a marked increase of keratinized tissue (> 4 mm) around both implants after 1 year of follow up. On a patient level, significantly reduced sensitivity around the implants and better home care were reported. This case report showed that the increase of keratinized tissue may benefit the clinical and patient outcomes of peri-implantitis treatment in terms of decreased probing depths, absence of inflammation, and improved radiographic crestal stability. The combined correction of both hard and soft tissue defects around peri-implantitis lesions may facilitate treatment success and help maintain peri-implant stability.

ПРИМЕНЕНИЕ КСЕНОГЕННОГО КОЛЛАГЕНОВОГО ГЕЛЯ И ЛАЗЕРНОГО ИЗЛУЧЕНИЯ ПРИ ПРОФИЛАКТИКЕ И ЛЕЧЕНИИ ПЕРИИМПЛАНТИТА: ПИЛОТНОЕ ИССЛЕДОВАНИЕ

Subject. The periimplantitis management and prophylaxis technique using xenogenic collagen gel and laser technique, analysis of their results.&#x0D; Aim. To evaluate the effect of periimplantitis management and prophylaxis with xenogenic collagen gel and laser technique. &#x0D; Methodology. The study was conducted on the basis of Sechenov University from 2020 to 2022. The study included ten patients with diagnosed peri-implantitis (age range 28–45 years, median is 35 years). All patients underwent professional hygiene followed by division into 2 groups by random sampling: patients of group 1 were injected with xenogenic collagen gel in the area of the peri-implant pocket and in the soft tissues around the dental implant in the area of alveolar bone resorption, patients of group 2 were subjected to laser bactericidal treatment of peri-implant pockets. The results were evaluated by the depth of probing of the peri-implant pocket and the clinical symptoms of the disease, the presence of adverse outcomes after the application of the techniques.&#x0D; Results. During 12 months of observation, a decrease in the depth of the peri-implant pocket during probing was noted by an average of 3 mm from the initial depth in both groups (p &lt; 0.05), an increase in the volume of soft tissues around the implants, mainly when xenogenic gel was used (p &lt; 0.05).&#x0D; Conclusions. Xenogenic collagen gel and laser microbiocidal treatment of peri-implant pockets may be an alternative treatment for peri-implantitis after full-fledged randomized clinical multicenter trials.

Non-surgical treatment of peri-implantitis with and without erythritol air-polishing a 12-month randomized controlled trial

BackgroundA variety of interventions have been explored in the non-surgical management of peri-implantitis. In spite of extensive testing of various study protocols, effective treatments largely remain unavailable. The objective of the present 12-month single-centre, examiner-masked, randomized controlled clinical trial was to explore whether a low-abrasive erythritol air-polishing system produces added clinical benefit when used adjunctive to conventional non-surgical management of peri-implantitis and to record any associated patient-centered outcomes.MethodsForty-three patients with mild to severe peri-implantitis including at least one implant either received ultrasonic/curette subgingival instrumentation and erythritol air-polishing (test) or ultrasonic/curette instrumentation only (control) at baseline and at 3, 6, 9, and 12 months. Probing depth (PD), bleeding on probing (BoP), dental plaque, suppuration (SUP), crestal bone level (CBL), and peri-implant crevicular fluid (PCF) were recorded at baseline, 6 and 12 months. Visual Analogue Scale (VAS) scores were collected immediately following subgingival interventions at all time-points.ResultsA reduction in PD was observed from baseline to 6 months for the test (p = 0.006) and control (p < 0.001) and from baseline to 12 months for the control (p < 0.001). No intergroup differences were observed for primary outcome variables PD or CBL over time (p > 0.05). At 6 months, a intergroup difference in PCF was observed in favor of the test (p = 0.042). Moreover, a reduction in SUP from baseline to 6 and 12 months was observed in the test (p = 0.019). Overall, patients in the control group experienced less pain/discomfort compared with the test (p < 0.05), females reporting more pain/discomfort than males (p = 0.005).ConclusionsThis study confirms that conventional non-surgical management of peri-implantitis produces limited clinical improvement. It is shown that an erythritol air-polishing system may not produce added clinical benefits when used adjunctive to conventional non-surgical management. In other words, neither approach effectively resolved peri-implantitis. Moreover, the erythritol air-polishing system produced added pain/discomfort particularly in female patients.Trial registrationThe clinical trial was prospectively registered in ClinicalTrials.gov with registration NCT04152668 (05/11/2019).

The efficacy of bone reconstructive therapies in the management of peri-implantitis. A systematic review and meta-analysis.

To evaluate the efficacy of bone reconstructive procedures for the reduction of probing pocket depth (PPD), bleeding on probing (BOP), and suppuration in peri-implantitis-related bone defects at ≥12-month follow-up. Three databases were searched for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared bone reconstructive therapies to access flap surgery (AFS) (Focused Question-FQ 1), and RCTs, CCTs, and prospective case series that assessed the efficacy of reconstructive therapies (FQ 2). Meta-analysis was performed for FQ1 when more than three studies were identified, while for FQ2 a network was drawn based on RCTs with common treatment arms. Seven RCTs were identified for FQ1 while five RCTs and six prospective case series for FQ2. There was no significant difference in PPD change between AFS and reconstructive surgery (-0.387; p=.325) at 12 months. Furthermore, no clear differences in terms of PPD and BOP changes resulted from the different reconstructive therapies included in the network. Only a small percentage of treated cases with any modality achieved peri-implantitis resolution, as defined by different composite outcomes. Reconstructive surgery does not offer significant improvements in peri-implant clinical parameters as compared to AFS at 12 months. It was not possible to establish a hierarchy of efficacy among the different biomaterials employed for reconstructive surgery.

Local and Systemic Antibiotics in Peri-Implantitis Management: An Umbrella Review.

The present umbrella review aimed to characterize the type and regimen of antibiotics administered locally and/or systemically, alone or in combination with surgical and nonsurgical treatments, for peri-implantitis and to evaluate and compare the associated clinical, radiographic, and crevicular peri-implant outcomes. The secondary objective was to determine the most effective antibiotic type, route of administration, regimen, and protocols (antibiotics alone or in combination with other approaches) for treating peri-implantitis. The study protocol, which was developed in advance under the PRISMA statement, was registered at PROSPERO (CRD42022373957). BioMed Central, Scopus, MEDLINE/PubMed, the Cochrane Library databases, and the PROSPERO registry were searched for systematic reviews through 15 November 2022. Of the 708 records found, seven reviews were included; three were judged of a critically low and four of low quality through the AMSTAR 2 tool. Locally administered antibiotics alone or as an adjunct to surgical or nonsurgical treatments for peri-implantitis showed favorable outcomes, albeit with limited evidence. The administration of systemically-delivered antibiotics in combination with nonsurgical or surgical treatments remained questionable. Local plus systemic antibiotics have not been shown to have durable efficacy. Due to the heterogeneity of reported antibiotic types, routes, regimens, and protocols, no definitive conclusions could be drawn regarding the most effective antibiotic use in treating peri-implantitis.