Therapy Of Peri-implantitis Research Articles

Bioimpedance measurements in dentistry to detect inflammation: numerical modelling and experimental results

Bioimpedance measurements represent an advantageous method to evaluate the physio-pathological conditions of biological tissues and their use is spreading in different application fields, from the evaluation of body composition to the vital signs monitoring, passing through the individuation of cancer tissues and the detection of different substances (e.g. glucose measurements in people affected by diabetes). In fact, tissues electric properties vary with their conditions; for example, electrical conductivity increases when there is an inflammatory process, because of the presence of oedema, hyperaemia and infiltration. Inflammatory phenomena are frequent in dentistry, in diseases like periodontitis and peri-implantitis; however, at present the diagnosis is mainly done with the naked eye, by observing the gingiva redness and swelling. Objective. The aim of this work is to prove the feasibility of the inflammation detection by means of bioimpedance measurements. Approach. Both numerical simulations and preliminary experimental measurements provide significant outcomes in differentiating between healthy and inflamed tissues. Main results. Percentage differences in the impedance modulus equal to 4–20% (numerical simulations) and 35–56% (experimental measurements), respectively, depending on the considered conditions (e.g. electrodes characteristics and inflammation severity), were found. Significance. Such a measure could be integrated in electromedical devices designed, for example, for the therapy of peri-implantitis, in order to personalise the therapeutic dose in terms of intensity and duration and focusing it on the impaired area, minimising the effects on the surrounding tissues.

Application of Ozone Nanobubble Water (ONBW) to Peri-Implantitis Treatment

In this case report, we investigated the effects of Ozone nanobubble water (ONBW) on peri-implantitis lesions with non-surgical treatment. ONBW preserves the ozone gas nucleus for more than 6 months although half life time of ozone water was almost 30 min. ONBW exerts anti-microbial activity towards several kinds of bacteria including periodontopathic bacteria and cariogenic bacteria. There was no cytotoxicity against oral epithelial and mucosa cells. The Advanced quick bonding (AQB) implants on 19 and 20 were placed on a patient 43 years old female four years ago. The chief complaint of her was swelling at the site of 20. The patient presented swollen at peri-implant area, Bleeding of probing (BOP), and probing depth (PD)=6 mm at buccal site of an implant of 20. There was no findings of mobility at concerned implant. The bone resorption and a radiolucent part around the implant was confirmed with periapical radiograph. The amount of bone loss was 5.0 and 6.5 mm at mesial and distal site of 20, respectively. This peri-implantitis was evaluated the case required surgical therapy. In addition to mechanical plaque control, the patient received regular professional oral hygiene treatment and irrigation with ONBW every week at 100 mL each. And also, regarding chemical plaque control, the irrigation for pockets was also performed at home by the patient at a frequency of three times a day every day. After 12 weeks, soft tissues of the peri-implant presented no clinical signs of inflammation and BOP, and PD was 3 mm. The bone levels did not change significantly as demonstrated by the follow-up roentgenography taken after 3 years. Microbiologically, the number of red-complex of periodontopathic bacteria have been decreased substantially. This case report supports that ONBW might be effective and predictable as an adjunctive therapy for peri-implantitis. To the best our knowledge, this is the first report on describing the peri-implantitis treatment with ONBW.

Periimplantitis Treatment

Periimplantitis is the most frequent cause of late implant failure; however, little is known about the long-term success of periimplantitis treatment and the effectiveness of various therapeutic interventions. A total of 142 patients were referred to the Academy for Oral Implantology in Vienna for the treatment of recurrent periimplantitis around single-tooth implants. Of them, 72 patients (51%) were treated by laser decontamination, 47 patients (33%) by implantoplasty surgery, and 23 patients (16%) by a combination of both approaches. Overall success of periimplantitis therapy was 89% after 9 years of follow-up, and it did not differ significantly between female and male patients (P = 0.426). The number of implant failures that could not be prevented by periimplantitis treatment was 6 after laser decontamination (8%), 6 after implantoplasty surgery (13%), and 4 after a combination of both therapies (17%). Implant loss occurred after 4.9 ± 1.9 years of therapy, on average. No significant difference between the 3 treatment groups could be observed (P = 0.393). The present results suggest that success rates of periimplantitis therapy with either laser decontamination or surgical implantoplasty are high. These success rates do not appear to be associated with patient gender or treatment strategy.

An innovative therapy for peri-implantitis based on radio frequency electric current: numerical simulation results and clinical evidence.

Peri-implantitis is a severe inflammatory pathology that affects soit and hard tissues surrounding dental implants. Nowadays, only prevention is effective to contrast peri-implantitis, but, in recent years, there is the clinical evidence of the efficiency of a therapy based on the application of radio frequency electric current, reporting that 81% of the cases (66 implants, 46 patients) were successfully treated. The aim of this paper is to present the therapy mechanism, exploring the distribution of the electric currents in normal and pathologic tissues. A 3D numerical FEM model of tooth root with a dental implant screwed in the alveolar bone has been realized and the therapy has been simulated in COMSOL Multiphysics® environment. Results show that the electric current is focused in the inflamed zone around the implant, due to the fact that its conductivity is higher than the healthy tissue one. Moreover, by means of a movable return electrode, the electric current and field lines can be guided in the most inflamed area, limiting the interference on healthy tissues and improving the therapy in the area of interest. In conclusion, it can be stated that this innovative therapy would make a personalized therapy for peri-implantitis possible, also through impedance measurements, allowing the clinician to evaluate the tissue inflammation state.

Effects of Surface Conditions of Titanium Dental Implants on Bacterial Adhesion.

The study is to evaluate the effect of surface roughness of titanium implants on bacterial adhesion and then to investigate the efficacy of the three cleaning treatments for bacterial removal in titanium surfaces. Although surface debridement is the basic element for treatment of peri-implantitis to reduce bacterial adhesion, adjunctive therapies such as antiseptics and laser debridement have been proposed to improve the nonsurgical treatment options of the peri-implant infection. Titanium specimens were divided into five groups: No. 1200 grit sandpaper polishing (Grit), 50 μm (SB50), 100 μm (SB100), and 250 μm Al2O3 sandblasting (SB250), and sandblasting, large-grit, and acid-etching (SLA). Surface roughness (Ra), contact angle, and surface morphology were examined. The subsequent adhesion of Escherichia coli on the different substrates was assayed. After 8 h of bacterial culture, three different cleaning treatments, including plastic curettage, air-powder abrasive system, and Er:YAG laser debridement, were applied on the specimens. The Ra value changed from the lower value of 0.2 μm for the Grit group to the significantly higher value of 2.7 μm for the SB250 group, indicating a significant difference from the SLA group (2.0 μm). The average contact angle of SLA (101°) was significantly higher than the other groups. No significant difference in E. coli bacterial adhesion was found among the all roughened groups, except the SB50 and SB250 groups at 12 h of culture. The use of three cleaning treatments did not induce significant surface alterations. However, the E. coli adhesion was significantly reduced in the air-powder abrasive system and laser debridement in comparison with that treated with the plastic curettage. Laser debridement could be a useful cleaning method for peri-implantitis therapy.

Insufficient evidence to support the use of laser therapy for peri-implantitis

Systematic review conclusionOn the basis of the limited information available about erbium:yttrium-aluminum-garnet (Er:YAG), carbon dioxide (CO2), and diode lasers, we could not identify any superiority of laser treatment in comparison with conventional treatment of peri-implantitis.Critical summary assessmentIn this well-conducted systematic review, the authors investigated the efficacy of laser therapy (Er:YAG, CO2, diode) for peri-implantitis and reported that laser therapy may be considered as a phase I nonsurgical treatment of peri-implantitis but that the benefits and clinical implications are unclear.Evidence quality ratingLimited. On the basis of the limited information available about erbium:yttrium-aluminum-garnet (Er:YAG), carbon dioxide (CO2), and diode lasers, we could not identify any superiority of laser treatment in comparison with conventional treatment of peri-implantitis.

In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach.

To assess the cleaning potential of commonly used implant debridement methods, simulating non-surgical peri-implantitis therapy invitro. One-hundred-and-eighty dental implants were ink-stained and mounted in combined soft and hard tissue models, representing peri-implantitis defects with angulations of 30, 60, and 90° covered by a custom-made artificial mucosa. Implants were treated by a dental school graduate and a board-certified periodontist for 120s with following instruments: Gracey curette, ultrasonic scaler, and an air powder abrasive device with a nozzle for sub-mucosal use utilizing glycine powder. All procedures were repeated 10 times for each instrumentation and defect morphology respectively. Images of the implant surface were taken. Areas with color remnants were planimetrically determined and their cumulative surface area was calculated. Results were tested for statistical differences using two-way anova and Bonferroni correction. Micro-morphologic surface changes were analyzed on scanning electron microscope (SEM) images. The areas of uncleaned surfaces (%, mean±standard deviations) for curettes, ultrasonic tips, and air abrasion accounted for 74.70±4.89%, 66.95±8.69% and 33.87±12.59% respectively. The air powder abrasive device showed significantly better results for all defect angulations (P<0.0001). SEM evaluation displayed considerable surface alterations after instrumentation with Gracey curettes and ultrasonic devices, whereas glycine powder did not result in any surface alterations. A complete surface cleaning could not be achieved regardless of the instrumentation method applied. The air powder abrasive device showed a superior cleaning potential for all defect angulations with better results at wide defects.

Two-year clinical outcomes following non-surgical mechanical therapy of peri-implantitis with adjunctive diode laser application.

Non-surgical mechanical therapy of peri-implantitis (PI) with/without adjunctive measures yields limited clinical improvements. To evaluate the clinical outcomes following non-surgical mechanical therapy of PI with adjunctive application of a diode laser after an observation period ≥2years. At baseline (BL), 15 patients with 23 implants with a sandblasted and acid-etched (SLA) surface diagnosed with PI were enrolled and treated. PI was defined as presence of probing pocket depths (PPD) ≥5mm with bleeding on probing (BoP) and/or suppuration and ≥2 threads with bone loss after delivery of the restoration. Implant sites were treated with carbon fiber and metal curettes followed by repeated application of a diode laser 3x for 30s (settings: 810nm, 2.5W, 50Hz, 10ms). This procedure was performed at Day 0 (i.e., baseline), 7 and 14. Adjunctive antiseptics or adjunctive systemic antibiotics were not prescribed. All implants were in function after 2years. The deepest PPD decreased from 7.5±2.6mm to 3.6±0.7mm at buccal (P<0.0001) and from 7.7±2.1mm to 3.8±0.9mm at oral sites (P<0.0001), respectively. The % of implants with ≥1 site with BoP decreased from 100% at BL to 43% after 2years (P=0.0002). The % of implants with suppuration decreased from 87% at BL to 0% after 2years (P<0.0001). Non-surgical mechanical therapy of PI with adjunctive repeated application of a diode laser yielded significant clinical improvements after an observation period of at least 2years.

Peri‐implant bone response to retrieved human zirconia oral implants after a 4‐year loading period: A histologic and histomorphometric evaluation of 22 cases

To evaluate the bone tissue response to surface modified zirconia oral implants retrieved from humans. Twenty-nine one-piece zirconia implants showed increased marginal bone loss and did not response to the applied peri-implantitis therapy. After their removal using a trephine bur, 22 of the implant-bone biopsies were suitable for an evaluation and immediately immersed in formalin for two weeks. Subsequent, the retrieved specimens were histologically prepared and the regions still showing osseointegration computer-assisted analyzed regarding the bone-to-implant contact (BIC) and bone density using a transmitted-light microscope. The removed implants were in situ for a mean time period of 47.7 months. After their removal, compact bone could be depicted at the apical regions. The remaining bone that was attached to the implants contained a regular lamellar structure with osteons and osteocytes. The BIC ranged from 58.1% to 93.7% (mean: 76.5%) and the bone area/density within the implant threads ranged from 57% to 97.2% (mean: 84.8%). The porous zirconia implants showed a sufficient BIC in the areas where bone still was attached. Although the implants had to be removed due to increased bone loss, it seems that the presented zirconia implant surface per se elicited appropriate osseointegration. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1622-1631, 2016.

Effectivity of air-abrasive powder based on glycine and tricalcium phosphate in removal of initial biofilm on titanium and zirconium oxide surfaces in an ex vivo model.

The purpose of the present study was the evaluation of effectiveness and efficiency of a powder consisting of glycine and tricalcium phosphate in comparison to two established powders based on glycine or sodium bicarbonate in biofilm removal on titanium and zirconium implant surfaces. Biofilm was collected for 48h by five volunteers. A total of 69 titanium and 69 zirconium samples were randomly assigned to test and control groups. Residual plaque areas (RPA) and treatment time were taken as parameters. Within the titanium groups, mean RPA was determined in the following descending order: sodium bicarbonate > glycine > glycine + tricalcium phosphate. Differences between the groups were significant, p<0.05. Mean treatment time in the titanium groups was determined in the following descending order without significant differences, p>0.05: glycine + tricalcium phosphate > sodium bicarbonate > glycine. Regarding the zirconium groups, mean RPA was detected in the following descending order, without significant differences, p>0.05: glycine > sodium bicarbonate > glycine + tricalcium phosphate. Mean treatment time of the glycine + tricalcium phosphate group was significantly lower than in the control groups, p<0.05. It can be concluded that glycine + tricalcium phosphate seemed to be more effective than the control groups for biofilm removal on titanium and zirconium implant surfaces. Especially on zirconium surfaces, decontamination with glycine + tricalcium phosphate seemed to be more efficient than treatment with glycine or sodium bicarbonate. The combination of glycine and tricalcium phosphate could improve the clinical outcomes of air-abrasive device in nonsurgical peri-implantitis therapy.

Treatment of peri-implantitis: clinical outcome of chloramine as an adjunctive to non-surgical therapy, a randomized clinical trial.

To evaluate the adjunctive clinical effects of a chloramine to non-surgical treatment of peri-implantitis. Eighteen individuals diagnosed with peri-implantitis (clinical signs of inflammation and progressive bone loss) on at least two implants were included. Clinical variables; plaque accumulation (Pl), probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BoP), were recorded at baseline and at 3-month follow-up. Primary clinical efficacy variable was the change in the number of sites with BoP. The implants were randomized into two different treatment groups: test and control. Both implants received supra- and submucosal debridement by ultrasonic instrumentation supplemented with hand instruments. The implants assigned to the test group first received local applications of a chloramine gel (Perisolv™ ; RLS Global AB, Gothenburg, Sweden) followed by mechanical instrumentation. The oral hygiene was checked at 6weeks. After 3months, implants of both groups showed statistically significant reduction (P<0.001) in the number of BoP-positive sites compared with baseline. The reduction of BoP-positive sites in the test group changed from 0.97 (SD±0.12) to 0.38 (SD±0.46), and in the control group from 0.97 (SD±0.12) to 0.31 (SD±0.42). Between-group comparisons revealed no statistically significant differences at baseline and after 3months, for BoP or any of the other variables. In the present randomized clinical trial of peri-implantitis therapy; non-surgical mechanical debridement with adjunctive use of a chloramine is equally effective in the reduction of mucosal inflammation as conventional non-surgical mechanical debridement up to 3months.

Nonsurgical treatment of peri-implantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine. Twelve-month follow-up of a prospective, randomized, controlled clinical study.

The purpose of this prospective, parallel group-designed, randomized controlled clinical study was the evaluation of the effectiveness of an air-abrasive device (AAD) for nonsurgical treatment of peri-implantitis. Twenty five patients, showing at least one implant with initial to moderate peri-implantitis, underwent an oral hygiene programme and were randomly treated using either (1) AAD (amino acid glycine powder) or (2) mechanical debridement using carbon curettes and antiseptic therapy with chlorhexidine digluconate (mechanical debridement (MDA)). Clinical parameters were measured at baseline and 12 months after treatment (e.g. bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL)). At 12 months, the AAD group revealed significantly higher (p < 0.05; unpaired t test) decrease in mean BOP scores when compared with MDA-treated sites (41.2 ± 29.5 vs. 16.6 ± 33.4%). Both groups exhibited comparable PD reductions (AAD = 0.5 ± 0.9 mm vs. MDA = 0.4 ± 0.9 mm) and CAL gains (AAD = 0.6 ± 1.3 mm vs. MDA = 0.5 ± 1.1 mm) (p > 0.05; Mann-Whitney test, respectively). Within its limitations, the present study has indicated that both treatment procedures resulted in comparable but limited CAL gains at 12 months. Furthermore, it could be detected that AAD was associated with significantly higher BOP decrease than MDA. The present results have indicated that nonsurgical therapy of peri-implantitis using both AAD and MDA resulted in comparable PD reductions and CAL gains after 12 months of healing. The BOP reductions were significantly higher in the AAD in comparison to the MDA group. So, AAD may be more effective for nonsurgical therapy of peri-implantitis than MDA.

Melatonin as a candidate therapeutic drug for protecting bone cells from chlorhexidine-induced damage.

Melatonin was proposed for use in periodontitis and peri-implantitis therapy due to its bone-supportive effects. This issue is of interest because standard adjuvant antiseptics, namely chlorhexidine (CHX), prove damaging for osteoblasts. Thus, the aim of this study is to investigate if melatonin is suitable as an auxiliary agent for protecting osteoblasts from CHX damage. MC3T3 osteoblast response was determined following administration of various CHX concentrations in the absence or presence of melatonin. Osteoblast morphology was evaluated, total reactive oxygen species (ROS) and superoxide levels were quantified, ratios of apoptotic and necrotic cells were identified by flow cytometry, metabolic activity of remaining cells was assessed, and effects were calculated with repeated measures analysis and post hoc P value adjustment. CHX led to poor morphology, increased total ROS and superoxide levels, and rigorously diminished the number of vital and metabolic active osteoblasts in a concentration-dependent manner. However, simultaneous melatonin supply supported cell morphogenesis and growth, reduced ROS and superoxide generation, shifted the percentage of CHX-damaged cells from necrotic/late to early apoptotic events, and modulated metabolic activity in osteoblasts. These data reveal that melatonin protects osteoblasts in the CHX context, thereby implicating melatonin as a promising drug in periodontitis and peri-implantitis treatment.

Management of peri-implant mucositis and peri-implantitis.

Peri-implant diseases are defined as inflammatory lesions of the surrounding peri-implant tissues and include peri-implant mucositis (an inflammatory lesion limited to the surrounding mucosa of an implant) and peri-implantitis (an inflammatory lesion of the mucosa that affects the supporting bone with resulting loss of osseointegration). This review aims to describe the different approaches to manage both entities and to provide a critical evaluation of the evidence available on their efficacy. Therapy of peri-implant mucositis and nonsurgical therapy of peri-implantitis usually involve mechanical debridement of the implant surface using curettes, ultrasonic devices, air-abrasive devices or lasers, with or without the adjunctive use of local antibiotics or antiseptics. The efficacy of these therapies has been demonstrated for mucositis: controlled clinical trials show an improvement in clinical parameters, especially in bleeding on probing. For peri-implantitis, the results are limited, especially in terms of probing pocket-depth reduction. Surgical therapy of peri-implantitis is indicated when nonsurgical therapy fails to control the inflammatory changes. Selection of the surgical technique should be based on the characteristics of the peri-implant lesion. In the presence of deep circumferential and intrabony defects, surgical interventions should aim to provide thorough debridement, implant-surface decontamination and defect reconstruction. In the presence of defects without clear bony walls or with a predominant suprabony component, the aim of the surgical intervention should be the thorough debridement and the repositioning of the marginal mucosa to enable the patient to perform effective oral-hygiene practices, although this aim may compromise the esthetic result of the implant-supported restoration.

A systematic review and Bayesian network meta-analysis of randomized clinical trials on non-surgical treatments for peri-implantitis.

It remains unclear which type of non-surgical treatment is most appropriate as first-line intervention against peri-implantitis. This systematic review and Bayesian network meta-analysis aimed to compare the clinical effect of various non-surgical peri-implantitis therapies. The PubMed, SCOPUS, CINAHL, DARE and Web of Knowledge databases were searched in duplicate for randomized controlled trials (RCTs) up to and including 01 January 2014. Additional relevant literature was identified using handsearching of reference lists within published systematic reviews, and screenings of OpenGrey, ClinicalTrials.gov and Controlled-Trials.com. Probing pocket depth (PPD) was the outcome measure assessed. Multilevel mixed modelling was used to perform the network meta-analysis, and Markov Chain Monte Carlo simulation to obtain random effects. Eleven studies were included in the network meta-analysis. Debridement in conjunction with antibiotics achieved the greatest additional PPD reduction in comparison to debridement only (0.490 mm; 95% credible interval: -0.647;1.252). The highest probabilities of being the most effective interventions were achieved by Vector system (p = 20.60%), debridement plus periochip (p = 20.00%) and photodynamic therapy (p = 18.90%). The differences between various non-surgical treatments were relatively small with large credible intervals. On the basis of currently available RCTs, there is insufficient evidence to support that any particular non-surgical treatment for peri-implantitis showed better performance than debridement alone.

Surgical Therapy for Peri-implantitis and Prognosis

Recently, more and more clinical cases of peri-implantitis for which surgical therapy is indicated have been reported. Ideal diagnostic modalities, prevelance, indicated therapy, and prognosis for peri-implantitis are still investigated. Scientific evidence of surgical therapy for peri-implantitis are not enough for now, and should be obtained from well-designed, long-term clinical studies in the future. When the surgical approach is applied for peri-implantitis, long-term prognosis of the surgical therapy should be kept in mind and importance of maintenance therapy also have to be emphasized.

Subcutaneous emphysema following non-surgical peri-implantitis therapy using an air abrasive device: a case report

Subcutaneous emphysema are rare complications in periodontology. In most cases, they resolve spontaneously. However, air might disperse into deeper facial spaces causing life-threatening complications such as compression of the tracheobronchial tree or the development of pneumomediastinum. Moreover, microorganisms might spread from the oral cavity into deeper spaces. Hence, rapid diagnosis of subcutaneous emphysema is important. Characteristic signs are both a shiftable swelling and a crepitation. In this case report, the case of a 69-year old man with a subcutaneous emphysema immediately after peri-implantitis therapy with the use of a glycine-based powder air-polishing device is described. Following therapy, air accumulated in the left side of the face. Seven days after non-surgical peri-implantitis therapy, the patient was asymptomatic with complete resolution of the emphysema.

Combined Surgical Resective and Regenerative Therapy for Advanced Peri-implantitis with Concomitant Soft Tissue Volume Augmentation: A Case Report

This case report presents a 3-year follow-up of the clinical outcomes of a combined surgical therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation using a collagen matrix. One patient suffering from advanced peri-implantitis and a thin mucosal biotype underwent access flap surgery, implantoplasty at buccally and supracrestally exposed implant parts, and augmentation of the intrabony components using a natural bone mineral and a native collagen membrane after surface decontamination. A collagen matrix was applied to the wound area to increase soft tissue volume and support transmucosal healing. The following clinical parameters were recorded over a period of 3 years: bleeding on probing (BOP), probing depth (PD), mucosal recession (MR), clinical attachment level (CAL), and width of keratinized mucosa (KM). At 36 months, the combined surgical procedure was associated with a clinically important reduction in mean BOP (100%), PD (4.3 ± 0.5 mm), and CAL (4.4 ± 0.4 mm). Site-level analysis of the buccal aspects pointed to an increase in MR (-1.0 ± 0.4 mm) and a decrease in KM (-1.3 ± 0.5 mm) values at 12 months. However, a regain in mucosal height and KM was noted at 24 months, even reaching respective baseline values after 36 months of healing. The presented combined surgical procedure was effective in controlling an advanced peri-implantitis lesion without compromising the overall esthetic outcome in the long term.

Implant decontamination with 2% chlorhexidine during surgical peri-implantitis treatment: a randomized, double-blind, controlled trial.

The objective of this randomized, double-blind, controlled trial was to evaluate the clinical, radiographic, and microbiological effects of implant surface decontamination with a 2% chlorhexidine (CHX) solution in comparison with a 0.12% chlorhexidine+0.05% cetylpyridinium chloride (CPC) solution during resective surgical peri-implantitis treatment. Forty-four patients (108 implants) with peri-implantitis were treated with resective surgical treatment consisting of bone re-contouring, surface debridement and chemical decontamination, and apically repositioned flap. Patients were randomly allocated to decontamination with a 2% CHX solution (test group) or 0.12% CHX+0.05% CPC (control group). Clinical and radiographic parameters were recorded before treatment (baseline), and at 3, 6, and 12months after treatment. Microbiological parameters were recorded during surgery. Multilevel analysis showed no significant differences in bleeding, suppuration, probing pocket depth, and radiographic bone loss between control and test group over three follow-up measurements (3, 6, and 12months) from baseline. Both decontamination procedures resulted in significant reductions in anaerobic bacterial counts on the implant surface, but no significant difference was noted between control and test group (mean log 3.37±2.34 vs. 3.65±2.87, P=0.99). The use of a 2% CHX solution for implant surface decontamination during resective peri-implantitis therapy does not lead to improved clinical, radiographic, or microbiological results compared with a 0.12% CHX+0.05% CPC solution. Overall, the additional use of CHX reduces anaerobic bacterial load on the implant surface better than mechanical debridement alone, but does not seem to enhance clinical treatment outcomes (ClinicalTrials.gov number NCT01852253).

Subcutaneous emphysema following non-surgical peri-implantitis therapy using an air abrasive device: a case report

Subcutaneous emphysema are rare complications in periodontology. In most cases, they resolve spontaneously. However, air might disperse into deeper facial spaces causing life-threatening complications such as compression of the tracheobronchial tree or the development of pneumomediastinum. Moreover, microorganisms might spread from the oral cavity into deeper spaces. Hence, rapid diagnosis of subcutaneous emphysema is important. Characteristic signs are both a shiftable swelling and a crepitation. In this case report, the case of a 69-year old man with a subcutaneous emphysema immediately after peri-implantitis therapy with the use of a glycine-based powder air-polishing device is described. Following therapy, air accumulated in the left side of the face. Seven days after non-surgical peri-implantitis therapy, the patient was asymptomatic with complete resolution of the emphysema.