Clinical and Radiographic Outcomes of Adjunctive Phototherapy Versus Antibiotic Therapy Against Peri-Implant Diseases: A Systematic Review and Meta-Analysis.

Background: Peri-implantitis, an inflammatory condition in implant tissues, requires bacterial eradication and implant surface decontamination, with aPDT as a helpful surgical adjunct. Objective:This project was designed to investigate the effect of antibiotic therapy versus aPDT, as adjuncts to conventional mechanical debridement (MD), on the peri-implant clinical and/or radiographic parameters among patients with peri-implant diseases. Methods: A comprehensive search was conducted across electronic databases, including PubMed, Scopus, and Web of Science, up to and including April 2023, without any restriction on the language and year of publication, focusing the following research question: "Does adjunctive aPDT improve the peri-implant clinical and/or radiographic parameters in treating peri-implant diseases compared to antibiotic therapy?" Statistical analysis was performed on peri-implant clinical [plaque index (PI), probing depth (PD), and bleeding on probing (BOP)] and radiographic parameters [marginal bone loss (MBL)]. The study included six randomized controlled trials and one clinical (nonrandomized) study. Results: The systematic review findings indicate that the application of aPDT as an adjunct to MD is equally effective as adjunctive antibiotic therapy in improving peri-implant clinical parameters and radiographic parameters in patients with peri-implant diseases. Only two studies were classified as having a low risk of bias (RoB), two were assessed as having an unclear RoB, and the remaining three studies were determined to have a high RoB. However, the meta-analysis results revealed no statistically significant difference in peri-implant PI, PD, and MBL scores between patients treated with adjunct aPDT or adjunct antibiotic therapy. Notably, there was a statistically significant difference favoring adjunct aPDT in peri-implant BOP values compared to the control group. Conclusions: Despite the limited number of included studies and the significant heterogeneity among them, the findings suggest that aPDT yields comparable peri-implant clinical and radiographic outcomes to adjunctive antibiotic therapy, as adjuncts to MD, for the potential treatment of peri-implant diseases.

Use of ozone therapy in Implant Dentistry: a systematic review.

PURPOSE: Ozone is a potent antioxidant agent which presents an important antimicrobial action and many other biological effects. Although ozone therapy has been widely described and summarized in several other Dentistry areas recently, the studies concerning Dental Implantology have not been systematically compiled and evaluated. Thus, the present study aimed to evaluate the effectiveness of ozone therapy in dental implant procedures. METHODS: MEDLINE (via PUBMED), Cochrane Central Register of Controlled Trials (CENTRAL), and OpenGrey databases were searched (up to, and including, January 23, 2023) for studies in the English language. In addition, the reference lists of the articles were manually examined. Only interventional studies (controlled clinical trials, randomized or not) were considered eligible for inclusion. The risk of bias in each included study was assessed using the Cochrane tool for assessing risk of bias in randomized trials - version 2. RESULTS: 71 potentially eligible records were retrieved but only 5 articles were evaluated and considered eligible for inclusion. Among the studies, 2 addressed clinical situations related to implant insertion, and 3 involved pathological conditions affecting implants in function. Furthermore, only one randomized clinical trial was categorized as low risk of bias. CONCLUSION: The adjuvant use of ozone therapy may positively affect some outcomes in Implant Dentistry, both in treating pathological conditions and conducting rehabilitation (implant installation, secondary implant stability). However, as most studies have a high risk of bias and high heterogeneity, a definitive conclusion cannot be drawn.

Clinical and radiographic peri-implant outcomes with riboflavin loaded Poly-L-glycolic acid nanoparticles incorporated in aloe-vera gel treating peri-implantitis in chronic hyperglycemic patients.

AIM: The objective of the current study was to compare the effectiveness of antimicrobial photodynamic therapy (PDT) versus Poly-L-glycolic acid nanoparticles loaded riboflavin incorporated in aloe vera gel (PGA/RF/AV) on periimplant parameters and bacterial counts in chronic hyperglycemic patients having periimplantitis. METHODS: One hundred and two diabetic patients undergoing mechanical debridement (MD) were equally divided into three groups: Group 1: PGA/RF/AV+ MD, Group 2: PDT + MD, and Group 3: MD alone. Periimplant parameters [Bleeding on probing (BoP), probing depth (PD), plaque index (PI), marginal bone level (MBL)] were recorded in all three groups. Periimplant plaque samples were studied to record the levels of Tannerella forsythia (Tf) and Porphyromonas gingivalis (Pg). The recordings were taken at baseline, 3 months and 6 months post treatment. RESULTS: All three groups showed a reduction in severity of periimplantitis measured in terms of PD, PI, MBL and BoP. A statistically significant reduction in PD, PI and MBL was found in patients in Group 2 whereas participants of Group 1 were found to have a significant decrease in BoP. A statistically significant decline in the numbers of both the bacterial species was seen in Group 2 at the three-month follow-up whereas at the six-month follow-up, a statistically significant reduction was observed in treatment Group 2 in the levels of Tf species only. CONCLUSION: Riboflavin-loaded nanocarrier incorporated in aloe vera gel showed greater clinical efficacy than PDT alone in the treatment of periimplantitis in chronic hyperglycemic individuals.

aMMP-8 point-of-care - diagnostic methods and treatment modalities in periodontitis and peri-implantitis.

INTRODUCTION: When collected in a standardized fashion, oral fluid analysis can refine the diagnosis of periodontal and peri-implant disease. In practice, dental professionals can perform active matrix metalloproteinase (aMMP-8) analysis chairside. AREAS COVERED: Periodontal tissues are mainly made up of type I collagen, and collagen breakdown is one of the main events in periodontal and peri-implantitis destructive lesions. In addition to traditional measurements, their diagnosis can be refined with tests utilizing oral fluids. The active matrix metalloproteinase-8 (aMMP-8) is possible to be determined from the gingival crevicular fluid (GCF), peri-implant sulcus fluid (PISF), and other oral fluids such as mouth rinse and saliva. We also investigated the applicability of aMMP-8 chair-side test kits in the evaluation of oral health benefits of different adjunctive host-modulating periodontal therapies including fermented lingonberry mouthwash (FLJ) and antibacterial photodynamic therapy (aPDT). EXPERT OPINION: The aMMP-8 levels can more reliably detect early activation of periodontal and peri-implant disease as compared to traditional diagnostic methods that assess the experienced health status or past disease, rather than the present or future pathology. Novel therapies like, fermented lingonberry juice as a mouthrinse or aPDT, are potential host-modulating adjunctive treatments to reduce the signs of oral inflammation and infection.

Influence of antiresorptive/antiangiogenic therapy on the extension of experimentally induced peri-implantitis lesions.

OBJECTIVES: To investigate the extension of experimentally induced peri-implantitis lesions under various antiresorptive and antiangiogenic medications. MATERIAL AND METHODS: Fourty-eight albino rats had randomly received the following medications (dual application, n = 8 each): (1) amino-bisphosphonate (zoledronate) (Zo), (2) RANKL inhibitor (denosumab) (De), (3) antiangiogenic (bevacizumab) (Be), (4) Zo+Be, (5) De+Be, or (6) no medication (Co). Ligature- and lipopolysaccharide-induced peri-implantitis lesions were established at 2 maxillary implants over a period of 16 weeks. Histological (e.g., apical extension and surface area of the inflammatory cell infiltrate-aICT, ICT; defect length; defect width; CD68 positive cells) and bone micromorphometric (µCT) outcomes were assessed. The animal was defined as a statistical unit. RESULTS: A total of n = 38 animals (Zo = 6, De = 6, Be = 8, Zo + Be = 6, De + Be = 5, Co = 7) were analyzed. ICT's were commonly marked by a positive CD68 antigen reactivity. Comparable median aICT (lowest-Zo: 0.53 mm; highest-Be: 1.22 mm), ICT (lowest-De + Be: 0.00 mm2; highest-Co: 0.49 mm2), defect length (lowest-Zo: 0.90 mm; highest-Co: 1.93 mm) and defect width (lowest-De+Be: 1.27 mm; highest-Be: 1.80 mm) values were noted in all test and control groups. Within an inner (diameter: 0.8 mm) cylindric volume of interest, the bone microstructure did not significantly differ between groups. CONCLUSIONS: The present analysis did not reveal any marked effects of various antiresorptive/ antiangiogenic medications on the extension of experimentally induced peri-implantitis lesions. CLINICAL RELEVANCE: The extension of peri-implantitis lesions may not be facilitated by the antiresorptive and antiangiogenic medications investigated.

Clinical Efficacy of Minocycline Hydrochloride for the Treatment of Peri-Implant Disease: A Systematic Review With Meta-Analysis of Randomized Controlled Trials.

This systematic review aimed to assess the clinical efficacy of the local application of minocycline hydrochloride for treating peri-implantitis. Four databases-PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure-were searched from their inception through December 2020. English and Chinese randomized controlled trials (RCTs) that compared minocycline hydrochloride with control regimes, including negative control, iodine solution or glycerin, and chlorhexidine, for patients with peri-implant diseases were retrieved. Three outcomes-plaque index (PLI), probing depth (PD), and sulcus bleeding index (SBI)-were assessed using meta-analysis based on the random-effects model. Fifteen RCTs were included in the present meta-analysis, and results suggested that minocycline hydrochloride significantly affected PLI, PD, or SBI reduction regardless of the type of comparator regime. However, subgroup analyses suggested that minocycline hydrochloride was not superior to chlorhexidine in terms of reduction of PLI (1 week: MD = -0.18, 95% CI = -0.55 to 0.20, P = .36; 4 weeks: MD = -0.08, 95% CI = -0.23 to 0.07, P = .28; 8 weeks: MD = -0.01, 95% CI = -0.18 to 0.16, P = .91) and PD (1 week: MD = 0.07, 95% CI = -0.27 to 0.41, P = .68; 4 weeks: MD = -0.10, 95% CI = -0.43 to 0.24, P = .58; 8 weeks: MD = -0.30, 95% CI = -0.68 to 0.08, P = .12), and minocycline hydrochloride was also not better than chlorhexidine regarding reduction of SBI at 1 week after treatment (MD = -0.10; 95% CI = -0.21 to 0.01; P = .08). This study concludes that minocycline hydrochloride as adjuvant therapy of nonsurgical treatment enhances the clinical results when compared to control regimes. However, the difference between minocycline hydrochloride and chlorhexidine should be further investigated by designing additional high-quality studies with large sample sizes.

Effects of an amino acid buffered hypochlorite solution as an adjunctive to air-powder abrasion in open-flap surface decontamination of implants failed for peri-implantitis: an ex vivo randomized clinical trial.

OBJECTIVES: To evaluate ex vivo the efficacy of an amino acid buffered hypochlorite solution supplemented to surface debridement with air-powder abrasion in removing bacterial biofilm following open-flap decontamination of implants failed due to peri-implantitis. MATERIALS AND METHODS: This study was an ex vivo, single-blind, randomized, intra-subject investigation. Study population consisted of 20 subjects with at least three implants failed for peri-implantitis (in function for > 12 months and progressive bone loss exceeding 50%) to be explanted. For each patient, implants were randomly assigned to surface decontamination with sodium bicarbonate air-powder abrasion (test-group 1) or sodium bicarbonate air-powder abrasion supplemented by amino acid buffered hypochlorite solution (test-group 2) or untreated control group. Following open-flap surgery, untreated implants (control group) were explanted. Afterwards, test implants were decontaminated according to allocation and explanted. Microbiological analysis was expressed in colony-forming units (CFU/ml). RESULTS: A statistically significant difference in the concentrations of CFU/ml was found between implants of test-group 1 (63,018.18 ± 228,599.36) (p = 0.007) and implants of test-group 2 (260.00 ± 375.80) (p < 0.001) compared to untreated implants (control group) (86,846.15 ± 266,689.44). The concentration of CFU/ml on implant surfaces was lower in test-group 2 than in test-group 1, with a statistically significant difference (p < 0.001). CONCLUSION: The additional application of amino acid buffered hypochlorite solution seemed to improve the effectiveness of implant surface decontamination with air-powder abrasion following open-flap surgery. CLINICAL RELEVANCE: Lacking evidence on the most effective method for biofilm removal from contaminated implant surfaces, the present experimental study provides further information for clinicians and researchers.

Effectiveness of ozone therapy in the treatment of periodontal diseases: a systematic review / Eficácia da ozonioterapia no tratamento de doenças periodontais: uma revisão sistemática

ABSTRACT The aim of this study was to evaluate the effectiveness of ozone as an adjuvant factor in the treatment of periodontal diseases. A systematic review was carried out using the PubMed, LILACS/BIREME, CoChrane, and Scielo databases and manual searches. Clinical studies published in English, Spanish, Portuguese, and French, between 1950 and 2020 that evaluated the effects of ozone in the treatment of periodontal diseases were included. The search resulted in 178 articles, of which 24 met the proposed eligibility criteria and were selected for this review. The risk of bias was assessed for each selected study in accordance with the Cochrane risk-of-bias tool - version 5.1.0. The selected studies evaluated the effect of ozone therapy on periodontitis, gingivitis, and peri-implant diseases. It was observed that the ozone in its oily form presented the best clinical results. In cases of periodontitis, it was concluded that ozone therapy in the gaseous form did not bring any additional benefit. With respect to gingivitis, ozone provided faster remission compared to the control group. And in peri-implant disease cases, ozone had the capacity to reduce the development of mucositis. Regarding microbiology, it was observed that ozone can continuously and significantly reduce periodontal microorganisms; however, with no difference from control groups. Further studies with adequate control of biases are suggested, using ozone in the oily or aqueous form, which are the most promising forms, also evaluating the possible effectiveness of ozone by-products.

RESUMO O objetivo deste estudo foi avaliar a eficácia do uso do ozônio como fator adjuvante no tratamento das doenças periodontais. Foi realizada uma revisão sistemática utilizando as bases de dados PubMed, LILACS/BIREME, CoChrane, Scielo e pesquisa manual. Foram incluídos estudos clínicos publicados em inglês, espanhol, português e francês entre 1950 e 2020, que avaliaram os efeitos do ozônio no tratamento de doenças periodontais. A busca resultou em 178 artigos, destes 24 estudos atenderam aos critérios de elegibilidade propostos e foram selecionados para esta revisão. Foi realizada a avaliação do risco de viés em cada estudo selecionado de acordo com a ferramenta de avaliação de risco de viés Cochrane Risk of Bias Tool - versão 5.1.0. Os estudos selecionados avaliaram o efeito da ozonioterapia na periodontite, gengivite e em doenças peri-implantares. Observou-se que a utilização do ozônio na forma oleosa foi a que apresentou os melhores resultados clínicos. Nos casos de periodontite, concluiu-se que a ozonioterapia não trouxe nenhum benefício adicional sob a forma gasosa. Em relação à gengivite, o ozônio proporcionou uma remissão mais rápida do que do grupo controle. E nas doenças peri-implantares, o ozônio foi capaz de reduzir o desenvolvimento da mucosite. Com relação a microbiologia, foi observado que o ozônio pode reduzir contínua e significativamente os microorganismos periodontais, contudo, sem diferença para grupos controle. Sugerem-se mais estudos com controle adequado de vieses, utilizando o ozônio de forma oleosa ou aquosa, formas mais promissoras, além da avaliação de possível eficácia de subprodutos do ozônio.

The antibacterial effect of Plectranthus scutellarioides (L.) R.Br. leaves extract against bacteria associated with peri-implantitis.

Background and aim: The present study investigates Plectranthus scutellarioides (L.) R.Br. as potential antibacterial oral rinse against bacteria associated with peri-implantitis to prevent the initial infection as well as disease progression. Experimental procedure: Phytochemical screening was done on P. scutellarioides lyophilized extract to identify the presence of chemical constituent by using mass-based identification. The extract was screened for its antibacterial activity against 4 Gram-positive aerobes (early colonizer) and 5 Gram-negative facultative anaerobes as well as obligate anaerobes (late colonizer) using disc diffusion method. The extract was tested for minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), its cytotoxicity effects on human gingival fibroblast cell (HnGF) as well as bacteria morphological changes by scanning electron microscopy (SEM). Results and conclusion: Four flavonoid compounds were identified namely quercetin-3-glucoside, quercitrin, quercetin 3-(6″-acetylglucoside) and quercetin 3-O-acetyl-rhamnoside. The sensitivity test revealed that P. scutellarioides extract was effective against all the bacteria tested. MIC concentrations for the Gram-positive aerobes were in the range of 1.56-12.50 mg/mL, and the MBC concentrations were within 3.13-12.50 mg/mL. For Gram-negative obligate anaerobes, the MIC concentration were within 3.13-12.50 mg/mL and MBC within 6.25-200.00 mg/mL. The ethanolic extract did not have any cytotoxic effect on HnGF cells at the tested concentrations. SEM images showed bacterial cell wall disruption for all the bacteria tested. The results showed that P. scutellarioides extract exerts its antibacterial property by disrupting the cell wall of all the bacteria tested. Hence, P. scutellarioides may benefit from further investigations on its safety for oral use as an adjunctive treatment for peri-implantitis.

Risk factors for periodontitis & peri-implantitis.

Risk is part of all health professions and generally indicates the chance of getting some form of illness. For dental practitioners this includes periodontitis or peri-implantitis, the focus of this issue. Many risk factors are involved in the development of disease and most likely interact or overlap. Most patients will probably have multiple risk factors, some of which will be the same for both periodontitis and peri-implantitis. The most recent classification of periodontal disease recognises the importance of risk factors and contemporary dental practice requires that clinicians be aware of and manage them. Broadly speaking risk factors can be patient, environment or practitioner related. Patient risk factors would include socio-economic status, smoking, substance use disorders, diabetes, diet and dietary supplements, mental health disorders, old age, poor home dental care or understanding of the need for good home care and use of medications. Environmental modification of the host response through gene function is an emerging risk factor. Lastly, practitioner-related factors in implant dentistry are now known to affect risk. These would include the use of digital technology, but patient related factors such implant location and the body's reaction to an implant itself add to the risk of developing disease. This edition of Periodontology provides an uptodate review of many of these risk factors and their impact summarising current knowledge.

Impact of Laser Therapy on Periodontal and Peri-Implant Diseases.

Objective: In the last few decades, lasers in dentistry have encompassed all branches in dentistry, with more focus in periodontology. In recent years, the use of lasers against periodontitis and peri-implantitis has undergone a decisive development that has involved various operational areas. The broadest applications were probably found in the clinical approach to soft tissues. Methods: Laser therapy is a novel technique that may provide further beneficial effects to conventional periodontal and peri-implant therapies. However, clinical evidence for the improvement of periodontal wound healing and tissue regeneration through laser treatment is still limited. Results: This review is aimed at assessing the advantages and disadvantages of the use of lasers in dental procedures and pathologies, focusing more on protocols for the management of periodontal and peri-implant diseases. Conclusions: The adjuvant action of laser therapy, in addition to conventional therapies for the management of periodontal and peri-implant disease, could induce benefits, but further investigation would be necessary to standardize better the protocols applied and to understand the actual tissue response to laser therapy.

A review on ozone therapy in periodontitis.

The biologic process of osseointegration (bone to implant interface), in which the implant forms an intimate relationship with the bone, provides the foundation for modern dental implants. Osseointegration necessitates a varying length of healing time. Despite the high success and survival rates of dental implants, problems do occur, necessitating ongoing periodontal and prosthodontic care. This failure frequently results in "peri-implantitis," which affects the soft and hard tissues surrounding the osseointegrated implants, resulting in the formation of a peri implant pocket and bone loss. Decontamination is a difficult feature of surgical regenerative therapy for peri-implantitis that has an impact on its success. Because microbial biofilms play such a significant part in the aetiology of peri-implant illnesses, it has long been assumed that eliminating microbial pathogens would be beneficial.

Is titanium alloy Ti-6Al-4 V cytotoxic to gingival fibroblasts-A systematic review.

OBJECTIVES: Grade V titanium alloy (Ti-6Al-4 V) is a well-recognized metallic biomaterial for medical implants. There has been some controversy regarding the use of this alloy in medical devices in relation to the toxicity of vanadium. In Dentistry, Ti-6Al-4 V remains prevalent. This systematic review aims to evaluate the effects of Ti-6Al-4 V on cells relevant to oral environments such as gingival fibroblasts. MATERIALS AND METHODS: A literature search was undertaken for relevant English language publications in the following databases: Dental and Oral Science, Medline and Web of Science. The electronic search was supplemented with a search of references. RESULTS: After application of inclusion and exclusion criteria. A total of eight papers are included in this review. These papers were all in vitro studies and were categorized into whole implant, discs, or implant particles based on the type of test materials used in the studies. CONCLUSION: Based on the analyses of the eight included studies in this review, if Ti-6Al-4 V as a material is unchallenged, i.e., as a whole implant in pH neutral environments, there appears to be little effect on fibroblasts. If Ti-6Al-4 V is challenged through corrosion or wear (particle release), the subsequent release of vanadium and aluminium particles has an increased cytotoxic effect in vitro in comparison to commercially pure titanium, hence concerns should be raised in the clinical setting.

Laser-assisted regenerative surgical therapy for peri-implantitis: A randomized controlled clinical trial.

BACKGROUND: Different surgical approaches have been proposed to treat peri-implantitis defects with limited effectiveness and predictability. Laser has been proposed as an effective tool to assist in bacterial decontamination and modulating peri-implant tissue inflammation. The aim of this pilot clinical trial was to evaluate the adjunctive benefits of Er:YAG laser irradiation for regenerative surgical therapy of peri-implantitis-associated osseous defects. METHODS: Twenty-four patients diagnosed with peri-implantitis with a radiographic infrabony defect were randomized into two groups. Both test and control groups received the following treatment: open flap mechanical debridement, supracrestal implantoplasty, bone grafting using a mixture of human allograft with demineralized bone matrix human allograft putty, and then covered with acellular dermal matrix membrane. The only difference in the test group was the adjunctive use of Er:YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface. Clinical assessments, including pocket depth (PD), clinical attachment level (CAL), and gingival index (GI) were performed by calibrated masked examiners for up to 6 months following surgery. Standardized radiographs were also taken to evaluate linear bone gain and defect bone fill. Student t-tests were used to analyze those clinical parameters. RESULTS: Both groups showed significant reductions in PD, GI, and CAL gain overtime. The test group demonstrated significantly higher PD reductions at the site level compared to the control group (2.65 ± 2.14 versus 1.85 ± 1.71 mm; test versus control, P = 0.014). There were no statistical differences found in CAL gain (1.90 ± 2.28 versus 1.47 ± 1.76 mm; test versus control), GI reduction (-1.14 ± 1.15 versus -1.04 ± 0.89; test versus control), radiographic linear bone gain (1.27 ± 1.14 versus 1.08 ± 1.04 mm; test versus control) or proportional defect size reduction (- 24.46 ± 19.00% versus -15.19 ± 23.56%; test versus control). There was a positive trend for test patients on PD reduction and CAL gain found in narrow infrabony defects. Major membrane exposure negatively impaired the overall treatment outcome of CAL gain (2.47 ± 1.84 versus 1.03 ± 1.48 mm; no/minor versus major exposure, P = 0.051) and PD reduction in the test group (-3.63 ± 2.11 versus -1.66 ± 1.26 mm, P = 0.049). CONCLUSION: This pilot study indicated using laser irradiation during peri-implantitis regenerative therapy may aid in better probing PD reduction. Nonetheless, a larger sample size and longer follow-up is needed to confirm if Er:YAG laser irradiation provides additional clinical benefits for peri-implantitis regenerative therapy (Clinicaltrials.gov: NCT03127228).

The influence of implant surface roughness on decontamination by antimicrobial photodynamic therapy and chemical agents: A preliminary study in vitro.

BACKGROUND: The aim of this preliminary study was to analyze the effectiveness of three different protocols of decontamination on five commercial moderate rough implants. MATERIAL AND METHODS: The types of implants investigated were: Neoporos Drive CM (CM; Neodent®), Drive CM Acqua (ACQ; Neodent®), SLActive (SLA; Straumann®), Osseotite (OT; Biomet 3i®) and Nanotite (NT; Biomet 3i®). Implant surface properties (n = 2/type of implant; control groups) were analyzed by scanning electron microscopy (SEM) images to determine surface roughness parameters (SRP) and energy disperse X-ray spectrometry to determine the chemical composition. Implants were then inoculated with Aggregatibacter actinomycetencomitans in vitro (n = 6/type of implant;experimental groups) and the contaminated areas were determined in SEM images (500x magnifications). Decontamination of implants was performed in duplicate by three protocols: antimicrobial photodynamic therapy (aPDT), EDTA associated with citric acid (EDTA + CA) and 0.12 % chlorhexidine (CHX). The remaining contaminated area (rCtA) was determined in SEM images (500x magnifications). All quantitative analysis through SEM images were analyzed in ImageJ® software for two-dimensional parameters. RESULTS: No significant differences were found in SRP among implants (control group), except for Rv (lowest valley) between SLA vs. OT (p=0.0031; Kruskal Wallis post hoc Dunn). NT implants showed highest contaminated area vs. ACQ implants (68.19 % ± 8.63 % and 57.32 % ± 5.38 %, respectively; p = 0.0016, Tukey's test). SRP after decontamination showed statistical difference for Ra (arithmetical mean deviation) for all decontamination groups when compared to control (p < 0.05; ANOVA with post-hoc Tukey's multiple comparisons test), only CM implants showed statistical difference when compared decontamination protocols to control with highest modification of SRP for EDTA + AC group. For decontamination analysis, for applicability of different protocols in the same type of implant, only SLA showed statistical significant difference for aPDT vs. EDTA + CA (p = 0.0114; ANOVA with post-hoc Tukey's multiple comparisons test) with lowest rCTA for aPDT, however for ACQ implants the aPDT showed lowest rCTA with no statistical difference (p > 0.05; ANOVA with post-hoc Tukey's multiple comparisons test). No statistical difference was observed between the decontamination protocols at other implant types. CONCLUSION: It can be suggested that the chemical-physical characteristics of dental implants can be effected by the process of contamination and decontamination by aPDT and chemical agents.

Utilización de láser diodo en el tratamiento de la peri-implantitis: reporte de 3 casos / Use of diode laser in peri-implantitis treatment: report of 3 cases

Los implantes dentales son ampliamente usados para el reemplazo de piezas dentarias y se han convertido en el "gold standard" de las terapias protésicas en odontología. Dado el mayor uso de éstos, las investigaciones epidemiológicas recientes han demostrado elevadas tasas de prevalencia de enfermedad periimplantaria. En el presente estudio se presentan tres casos clínicos diagnosticados con periimplantitis. Todos los casos presentaron aumento de la profundidad al sondaje periimplantario en relación a controles anteriores, supuración, sangramiento al sondaje y pérdida ósea confirmada a través de tomografía computada cone beam. El tratamiento indicado para todos los casos fue una terapia conjunta entre un tratamiento mecánico mediante ultrasonido con la utilización de puntas plásticas (P.I EMS®, Suiza) y la terapia con láser. Para la laserterapia se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia de 2 W en modo CW, utilizando una punta de 300 µm. El láser de diodo no daña la superficie de titanio y es capaz de descontaminar las superficies rugosas de los implantes. En este reporte, el uso de una terapia combinada mecánica y láser fue efectiva en todos los casos. En los controles clínicos, la mucosa periimplantaria no presentó signos de supuración ni sangramiento, y la profundidad al sondaje también se vió disminuída. El nivel óseo se controló a través de una tomografía computada cone beam y no se evidenciaron cambios significativos. En la actualidad, la evidencia clínica para el tratamiento periimplantario mediante la fototerapia todavía es limitada. Sin embargo, el láser ofrece un enfoque técnico novedoso que es completamente diferente de los instrumentos mecánicos y tiene varios efectos beneficiosos, por lo que puede desempeñar un papel importante, en la resolución de la peri-implantitis.

Dental implants are widely used for the replacement of teeth and have become the "gold standard" of prosthetic therapies in dentistry. Given the increased use of these, recent epidemiological investigations have shown high prevalence rates of peri-implant disease. In the present study, three clinical cases diagnosed with peri-implantitis are presented. All cases presented increased depth to peri-implant probing in relation to previous controls, suppuration, bleeding and bone loss confirmed by cone beam computed tomography. The treatment indicated for all cases was a joint therapy between a mechanical ultrasound treatment with the use of plastic tips (P.I EMS®, Switzerland) and laser therapy. For laser therapy, a 940 nm diode laser equipment was used (Biolase®, USA) with a power of 2W in continuous laser beam mode, using a 300 µm tip. The diode laser does not damage the titanium surface and is capable of decontaminating the rough surfaces of the implants. In this report, the use of a combined mechanical and laser therapy was effective in all cases. In clinical controls, the peri-implant mucosa did not show signs of suppuration or bleeding, and the depth on probing was decreased. The bone level was controlled through a cone beam computed tomography and no significant changes were evidenced. At present, the clinical evidence for peri-implant treatment using phototherapy is still limited. However, the laser offers a novel technical approach that is completely different from mechanical instruments and has several beneficial effects, so it can play an important role in the resolution of peri-implantitis.

Anti-inflammatory and macrophage polarization effects of Cranberry Proanthocyanidins (PACs) for periodontal and peri-implant disease therapy.

BACKGROUND AND OBJECTIVE: Macrophages' cytokine expression and polarization play a substantial role in the host's "destructive" inflammatory response to periodontal and peri-implant pathogens. This study aimed to evaluate cell viability, anti-inflammatory activity, and macrophage polarization properties of different cranberry concentrates. METHODS: THP-1 cells (monocytic line) were treated with phorbol myristic acid to induce macrophage differentiation. Human gingival fibroblasts (HFIB-G cell line), osteosarcoma-derived osteoblasts (SAOS-2 cell line), and induced macrophages were treated with cranberry concentrates at 25, 50, and 100 µg/mL for 120 seconds, 1 hour and 24 hours. Untreated cells at the same time points served as controls. For anti-inflammatory analysis, induced macrophages exposed to cranberry concentrates (A-type PACs) were stimulated with lipopolysaccharides (LPS) derived from E coli for 24 hours. Cell viability, interleukin (IL)-8, IL-1 ß, IL-6, and IL-10 expression of LPS-stimulated macrophages, and macrophage polarization markers were evaluated through determination of live-cell protease activity, enzyme-linked immunosorbent assay, and immunofluorescence staining semi-quantification. RESULTS: Cranberry concentrates (A-type PACs) did not reduce HGF, SAOS-2, and macrophage viability after 24 hours of exposure. Pro-inflammatory cytokine expression (ie IL-8 and IL-6) was downregulated in LPS-stimulated macrophages by cranberry concentrates at 50 and 100 µg/mL. Anti-inflammatory IL-10 expression was significantly upregulated in LPS-stimulated macrophages by cranberry concentrates at 100 µg/mL after 24 hours of exposure. M1 polarization significantly decreased when LPS-stimulated macrophages were exposed to cranberry concentrates. High levels of positive M1 macrophages were present in all untreated control groups. M2 polarization significantly increased at all LPS-stimulated macrophages exposed to cranberry concentrates for 1 and 24 hours. CONCLUSION: Cranberry-derived proanthocyanidins may have the potential to act as an anti-inflammatory component in the therapy of periodontal and peri-implant diseases.

Limited Evidence Suggests That Adjunctive Antimicrobial Photodynamic Therapy May Not Provide Additional Clinical Benefit to Conventional Instrumentation Strategy Alone in Periodontitis and Peri-implantitis Patients.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Antimicrobial photodynamic therapy for the treatment of periodontitis and peri-implantitis: An American Academy of Periodontology best evidence review. Chambrone L, Wang H-L, Romanos GE. J Periodontol 89(7):783-803. SOURCE OF FUNDING: The publication was affiliated with the American Academy of Periodontology Best Evidence Consensus meeting on lasers was sponsored by J. Morita USA (Irvine, California), a manufacturer of dental laser products. Manuscript acknowledges that the funding was garnered through support from the individual authors' institutions. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Mangiferin alleviates experimental peri-implantitis via suppressing interleukin-6 production and Toll-like receptor 2 signaling pathway.

BACKGROUND: TLR2 (Toll-like receptor 2) signaling and its downstream proinflammatory cytokines are considered to be important in the progression of peri-implantitis. A natural medicine, mangiferin has exhibited modulatory effect on TLR2 signaling and anti-inflammatory effects on different diseases. The objective of the present study is to investigate the effect of mangiferin on peri-implantitis and the potential mechanisms by administering this drug to an experimental peri-implantitis mouse model. METHODS: Maxillary left first, second, and third molars of mice were extracted, and dental implants were placed in the region of the maxillary left second molars. Then, peri-implantitis was induced by tying ligatures around implants, and mangiferin was given orally to the mice. After 6-week mangiferin treatment, bone loss around the implants was detected using micro-computerized tomography (micro-CT). Alveolar bone and inflammatory infiltrate in peri-implant tissues were examined using hematoxylin and eosin (H&E) staining. Production of interleukin-6 (IL6), a TLR2 downstream proinflammatory cytokine, in the tissue surrounding implants was measured using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) analysis. IL6 protein expression and TLR2 signaling pathway activation in peri-implant tissues were detected using western blot analysis. RESULTS: Micro-CT demonstrated reduced bone loss in peri-implantitis upon mangiferin administration. Additionally, H&E staining showed more alveolar bone and less inflammatory infiltrate in peri-implant tissues after mangiferin application. Moreover, qRT-PCR analysis demonstrated lower levels of IL6 gene expression, and western blot analysis showed decreased protein expression of IL6 and TLR2, and suppressed phosphorylation of TLR2 downstream nuclear factor-κB, p38 mitogen-activated protein kinase, and c-Jun N-terminal kinase after mangiferin treatment. CONCLUSIONS: These results suggest the suppressive effect of mangiferin on bone damage and inflammatory infiltrate in peri-implantitis. These therapeutic effects may be associated with inhibited IL6 production and reduced TLR2 signaling activation in peri-implant tissues.

Photothermal Effects of Defocused Initiated Versus Noninitiated Diode Implant Irradiation.

Background: Diode lasers have been used for implant decontamination. However, the use of initiated or noninitiated tips remains unevaluated to verify potential photothermal risks. Objective: To assess the photothermal effects of defocused-initiated versus noninitiated irradiation. Materials and methods: A dental implant (3.5 × 11 mm) was placed into an artificial bone, an infrabony defect was created to simulate a four-wall peri-implant defect. Irradiation was performed using pulsed diode lasers of 940, 975, and 980 nm. The laser tips were positioned parallel to the implant (maximum 2W pulsed mode). The implant was irradiated for 30 sec using noninitiated, cork-, and blue paper-initiated tips. Temperature differences were observed at the apical and coronal regions of the implant. The data were statistically evaluated and compared using one-way analysis of variance and Tukey tests. Results: The average temperature increase and the amount of time that it took to yield the critical temperature were comparable at the coronal level for the 940 and 975 nm diode lasers (p > 0.05). For the 980 nm laser, blue-initiated tip had the highest temperature increase (22.4°C), followed by cork (18.8°C) and noninitiated tip (17.3°C). The critical threshold at the coronal portion for the 980 nm laser was reached in 11.5, 8.79, and 6.46 sec for the blue paper-, cork-, and noninitiated tips, respectively. The 975 and 980 nm lasers had average temperature increases, comparable among the blue paper-, cork-, and noninitiated tips at the apical level (p > 0.05). Apically, for the 940 nm, the noninitiated tip had the highest temperature increase (5.57°C), followed by the cork- (4.96°C) and blue paper-initiated tip (4.54°C). Conclusions: The initiator does not affect the temperatures produced during implant decontamination although noninitiated diode lasers may overheat (within 30 sec) than initiated tips. There is minimal risk of overheating at the apical portion. It seems that the 940 nm diode is the safest of the evaluated laser systems.