Open flap debridement of peri-implantitis with or without adjunctive systemic antibiotics: A randomized clinical trial.

AIMS: To investigate clinical, radiographic and microbiological outcome over 12 months following open flap debridement of peri-implantitis with or without antibiotics. MATERIALS AND METHODS: Peri-implantitis was surgically treated with or without Zithromax® in 19 control and 20 test individuals. Probing pocket depth (PPD), gingival inflammation (BOP), intra-oral radiographs and microbial samples were studied. Per protocol and intent-to-treat analyses were performed. RESULTS: The mean difference (reduction) in PPD values between baseline and month 12 in the test and control groups was 1.7 mm (SD ± 1.1, 95% CI: 1.1, 2.3, p < .001) and 1.6 mm (SD ± 1.5, 95% CI: 0.8, 2,4, p < .001), respectively. Data analysis failed to show study group differences for BOP, PPD, radiographic bone level and microbial load. Successful treatment (per protocol: PPD ≤ 5 mm, no BOP, no suppuration and no bone loss ≥0.5 mm) at 12 months in test and control groups was 7/15 (46.7%) and 4/16 (25.0%). Bacterial load reduction was similar in study groups with a temporary reduction following treatment. CONCLUSIONS: Surgical treatment of peri-implantitis with adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with those only receiving open flap debridement.

Probiotic supplements and debridement of peri-implant mucositis: a randomized controlled trial.

OBJECTIVE: The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis. MATERIALS AND METHODS: Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays. RESULTS: After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups. CONCLUSIONS: Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo.

Effect of probiotic lozenges on inflammatory reactions and oral biofilm during experimental gingivitis.

AIM: Probiotic bacteria have been introduced for prevention and treatment of periodontal diseases. The aim was to assess if daily oral administration of probiotic bacteria could influence the inflammatory response and the composition of supragingival plaque in an experimental gingivitis model. MATERIALS AND METHODS: Eighteen healthy female adults volunteered after informed consent. A double-blind randomized placebo-controlled cross-over design was used. The buccal surface of first molars was used as experimental sites. A mouth-guard covering the first premolar to second molar was used when brushing, preventing accidental cleaning during 3 weeks of plaque accumulation. Lozenges containing L. reuteri (ATCC55730 and ATCC PTA5289) or placebo were taken twice a day. During the run-in and washout periods, professional tooth cleaning was performed 5 days/week. At baseline and follow-up, plaque index, gingival index and bleeding on probing were recorded. Samples of gingival crevicular fluid (GCF) were analysed for concentration of seven inflammatory mediators. Bacterial samples were processed with checkerboard DNA/DNA-hybridization. RESULTS: All subjects presented a local plaque accumulation and developed manifest gingivitis at the test sites during the intervention periods. The volume of GCF increased in both groups but was statistically significant only in the placebo group (p < 0.05). The concentrations of IL1-ß and IL-18 increased significantly (p < 0.05), while IL-8 and MIP1-ß decreased (p < 0.05). No differences were displayed between test and placebo. Likewise, the microbial composition did not differ between the groups. CONCLUSION: Daily intake of probiotic lozenges did not seem to significantly affect the plaque accumulation, inflammatory reaction or the composition of the biofilm during experimental gingivitis.

Systemic antibiotics and debridement of peri-implant mucositis. A randomized clinical trial.

BACKGROUND: This RCT compared non-surgical treatment of peri-implant mucositis with or without systemic antibiotics. MATERIALS AND METHODS: Forty-eight subjects received non-surgical debridement with or without systemic Azithromax (®) (4 days), and were followed during 6 months. The checkerboard DNA-DNA hybridization method was used to analyse the microbiological material. RESULTS: Five subjects were excluded due to antibiotic medication during follow-up. At baseline,1 and 3 months no group differences were found. Statistical analysis failed to demonstrate differences in probing pocket depths (PPD) values at 6 months (Mean diff PPD: 0.5 mm, SE: ±0.4 mm, 95% CI: -0.2, 1.3, p = 0.16). Mean% implant bleeding decreased between baseline and month 6 from 82.6% to 27.3% in the test, and from 80.0% to 47.5% in the control group (p < 0.02). Throughout the study, no study group differences in bacterial counts were found. CONCLUSION: No short-term differences were found between study groups. The clinical improvements observed at 6 months may be attributed to improvements in oral hygiene. The present study does not provide evidence for the use of systemic antibiotics in treatment of peri-implant mucositis.