The Peri-Implant Microbiome-A Possible Factor Determining the Success of Surgical Peri-Implantitis Treatment?

The objective was to assess the effect of peri-implantitis surgery on the peri-implant microbiome with a follow-up of one year. A total of 25 peri-implantitis patients in whom non-surgical treatment has failed to solve peri-implantitis underwent resective surgical treatment. Their peri-implant pockets were sampled prior to surgical treatment (T0) and one year post treatment (T12). The natural dentition was sampled to analyse similarities and differences with the peri-implantitis samples. Treatment success was recorded. The change in microbial relative abundance levels was evaluated. The microbiota was analysed by sequencing the amplified V3-V4 region of the 16S rRNA genes. Sequence data were binned to amplicon sequence variants that were assigned to bacterial genera. Group differences were analysed using principal coordinate analysis, Wilcoxon signed rank tests, and t-tests. Beta diversity analyses reported a significant separation between peri-implantitis and natural dentition samples on T0 and T12, along with significant separations between successfully and non-successfully treated patients. Eubacterium was significantly lower on T12 compared to T0 for the peri-implantitis samples. Treponema and Eubacterium abundance levels were significantly lower in patients with treatment success on T0 and T12 versus no treatment success. Therefore, lower baseline levels of Treponema and Eubacterium seem to be associated with treatment success of peri-implantitis surgery. This study might aid clinicians in determining which peri-implantitis cases might be suitable for treatment and give a prognosis with regard to treatment success.

Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial.

OBJECTIVES: To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri-implantitis. MATERIAL AND METHODS: During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline-soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow-up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full-mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann-Whitney U test. RESULTS: No differences between the test and control group were found for BoP over 12 months of follow-up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1-year follow-up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%). CONCLUSIONS: Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri-implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success. TRIAL REGISTRY: https://www.trialregister.nl/ Identifier: NL8621.

Systemic antibiotic therapy as an adjunct to non-surgical peri-implantitis treatment: A single-blind RCT.

AIM: The aim of this single-blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non-surgical treatment of peri-implantitis. MATERIAL AND METHODS: Patients (N = 62) with peri-implantitis were randomly assigned to receive full-mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T0 ) to 3-month follow-up (T3 ). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis. RESULTS: 57 patients with 122 implants completed 3-month follow-up. Both groups showed major clinical improvements at T3 in both peri-implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters. CONCLUSIONS: Systemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non-surgical peri-implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full-mouth non-surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri-implantitis treatment phase.

Implant decontamination with phosphoric acid during surgical peri-implantitis treatment: a RCT.

BACKGROUND: Peri-implantitis is known as an infectious disease that affects the peri-implant soft and hard tissue. Today, scientific literature provides very little evidence for an effective intervention protocol for treatment of peri-implantitis. The aim of the present randomized controlled trial is to evaluate the microbiological and clinical effectiveness of phosphoric acid as a decontaminating agent of the implant surface during surgical peri-implantitis treatment. METHODS: Peri-implantitis lesions were treated with resective surgical treatment aimed at peri-implant granulation tissue removal, bone recontouring, and pocket elimination. Fifty-three implant surfaces in 28 patients were mechanically cleaned and treated with either 35% phosphoric etching gel (test group) or sterile saline (control group). Microbiological samples were obtained during surgery; clinical parameters were recorded at baseline and at 3 months after treatment. Data were analyzed using multi-variable linear regression analysis and multilevel statistics. RESULTS: Significant immediate reductions in total anaerobic bacterial counts on the implant surface were found in both groups. Immediate reduction was greater when phosphoric acid was used. The difference in log-transformed mean anaerobic counts between both procedures was not statistical significant (p = 0.108), but there were significantly less culture-positive implants after the decontamination procedure in the phosphoric acid group (p = 0.042). At 3 months post-surgery, 75% of the implants in the control group and 63.3% of the implants in the test group showed disease resolution. However, no significant differences in clinical and microbiological outcomes between both groups were found. CONCLUSIONS: The application of 35% phosphoric acid after mechanical debridement is superior to mechanical debridement combined with sterile saline rinsing for decontamination of the implant surface during surgical peri-implantitis treatment. However, phosphoric acid as implant surface decontaminant does not seem to enhance clinical outcomes on a 3-month follow-up. TRIAL REGISTRATION: Netherlands National Trial Register, NTR5185 (www.trialregister.nl).

Prognostic indicators for surgical peri-implantitis treatment.

OBJECTIVES: Objective of this study was to identify prognostic indicators for the outcome of resective peri-implantitis treatment, by an analysis of the pooled data of two previously conducted randomized controlled trials. MATERIAL AND METHODS: Data of 74 patients with peri-implantitis (187 implants) who had received resective surgical treatment were available. Primary outcome variable was failure of peri-implantitis treatment after 12 months. Multilevel univariable and multiple logistic regression analyses were performed to evaluate the effect of various potentially prognostic indicators on the primary outcome. RESULTS: Peri-implantitis treatment was unsuccessful in 106 implants (57%) and 48 patients (67%) after 12 months. In the multiple regression analysis, the variables "order of inclusion" (P = 0.016) and mean bone loss at baseline (P = 0.030) were significant prognostic indicators for treatment failure. To eliminate the effect of "order of inclusion," post hoc analyses were carried out in a subgroup of patients. The univariable post hoc analysis showed a significant association for smoking (P = 0.015), maximum pocket depth at baseline (P = 0.073), mean bone loss at baseline (P = 0.003), and presence of plaque (P = 0.100). In the multiple regression post hoc analysis, only the variables smoking (P = 0.044) and mean bone loss (P = 0.043) remained statistically significant. CONCLUSIONS: The outcome of surgical peri-implantitis treatment is influenced by the experience of the surgical team with the surgical procedure. The observed learning effect has consequences for clinical practice and for conducting and interpreting clinical trials on peri-implantitis treatment. Other prognostic indicators are amount of peri-implant bone loss at baseline and smoking, and to a lesser extent, probing pocket depth at baseline and presence of plaque during follow-up. Early diagnosis of peri-implantitis and control of behavioral factors are crucial in achieving peri-implantitis treatment success.

Incidence of peri-implant mucositis and peri-implantitis in edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period.

OBJECTIVES: The aim of this sub-analysis of two prospective studies was to assess the incidence of peri-implant mucositis and peri-implantitis in fully edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period. MATERIAL AND METHODS: One hundred and fifty edentulous patients with two endosseous implants to support a mandibular overdenture were available from two prospective studies. Clinical and radiographic parameters were assessed at 5 and 10 years of functional loading. Incidence of peri-implant mucositis and peri-implantitis were calculated at implant level and patient level following the Consensus of the Seventh European Workshop on Periodontology on peri-implant diseases. RESULTS: Incidence of peri-implant mucositis at patient level was 51.9% after 5 years of evaluation and 57.0% after 10 years. Incidence of peri-implantitis at patient level was 16.9% after 5 years of evaluation and 29.7% after 10 years. CONCLUSION: Peri-implant mucositis and peri-implantitis do occur in totally edentulous patients and incidence numbers are high.

Differences in peri-implant conditions between fully and partially edentulous subjects: a systematic review.

AIM: The aim of this study was to compare peri-implant conditions between fully edentulous (FES) and partially edentulous subjects (PES). MATERIAL AND METHODS: A systematic review was conducted. The MEDLINE, EMBASE and COCHRANE databases were searched for publications up to January 1st 2012. Studies reporting on the bleeding tendency of the peri-implant mucosa and/or studies reporting on the prevalence of peri-implant mucositis and/or peri-implantitis were considered. RESULTS: Fifty-five publications describing 46 studies were selected. One study described both FES and PES, and all other studies described either FES or PES. Subgroup analyses were performed according to dental status (fully/partially edentulous), follow-up time (≥5 years and ≥ 10 years) and study design (prospective/cross-sectional). FES harboured more plaque at their implants than PES. Modified bleeding index scores were significantly higher in FES, but no differences in bleeding on probing, implant loss and probing pocket depth were observed between FES and PES. No meta-analysis could be performed on prevalence of peri-implant mucositis and peri-implantitis. Overall prevalence of peri-implantitis was 0-3.4% after 5 years and 5.8-16.9% after 10 years of implant evaluation. CONCLUSION: FES and PES show comparable implant survival rates. However, no conclusion can be drawn regarding differences in prevalence of peri-implant mucositis and peri-implantitis between FES and PES.

Implant decontamination during surgical peri-implantitis treatment: a randomized, double-blind, placebo-controlled trial.

AIM: The objective of this randomized, double-blind, placebo-controlled trial was to study the effect of implant surface decontamination with chlorhexidine (CHX)/cetylpyridinium chloride (CPC) on microbiological and clinical parameters. MATERIAL & METHODS: Thirty patients (79 implants) with peri-implantitis were treated with resective surgical treatment consisting of apically re-positioned flap, bone re-contouring and surface debridement and decontamination. Patients were randomly allocated to decontamination with 0.12% CHX + 0.05% CPC (test-group) or a placebo-solution (without CHX/CPC, placebo-group). Microbiological parameters were recorded during surgery; clinical and radiographical parameters were recorded before (pre-) treatment (baseline), and at 3, 6 and 12 months after treatment. RESULTS: Nine implants in two patients in the placebo-group were lost due to severe persisting peri-implantitis. Both decontamination procedures resulted in significant reductions of bacterial load on the implant surface, but the test-group showed a significantly greater reduction than the placebo-group (log 4.21 ± 1.89 versus log 2.77 ± 2.12, p = 0.006). Multilevel analysis showed no differences between both groups in the effect of the intervention on bleeding, suppuration, probing pocket depth and radiographical bone loss over time. CONCLUSION: Implant surface decontamination with 0.12% CHX + 0.05% CPC in resective surgical treatment of peri-implantitis leads to a greater immediate suppression of anaerobic bacteria on the implant surface than a placebo-solution, but does not lead to superior clinical results. The long-term microbiological effect remains unknown.