Supervisors info:
Μπομπέτσης Γεώργιος, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Δερέκα Ξανθίππη, Αναπληρώτρια Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Βασιλόπουλος Σπυρίδων, Επίκουρος Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
Aim: To compare the 3-month clinical and microbiological changes following 2 different surgical treatment modalities of peri-implantitis, one with the adjunctive application of an erythritol air-abrasive device and the other with implantoplasty. Secondarily, comparison of the microbial profile of 5 key periodontal pathogens between healthy implants and implants with peri-implantitis before and after treatment was performed. Patients’ satisfaction following the two surgical modalities was also evaluated.
Materials and methods: A randomized -controlled clinical trial was carried out in 19 non-smoking subjects (19 implants) diagnosed with peri-implantitis (intervention group). A control group of 20 non-smokers (20 implants) with implants diagnosed with peri-implant health was also recruited and followed-up during the same observation period. Patients in the test group received a first step of non-surgical debridement. At the 6-week evaluation, implants not fulfilling therapy endpoints, defined by the composite outcome including presence of probing depths (PPD) ≤5 mm with no more than one site exhibiting bleeding on probing presented as a single spot [modified bleeding index (MBI) score 1] and absence of suppuration (SoP), underwent resective surgical therapy. Implant surface decontamination protocol included mechanical debridement with the use of titanium brushes and the subsequent application of an erythritol-based air abrasive device (AFL group) or implantoplasty (IPP group), based on a randomization list. Patients in the control group underwent supragingival professional mechanical plaque removal with the application of erythritol-based air abrasion at the baseline examination. Clinical and microbiological outcomes were evaluated at baseline, 6 weeks after non-surgical therapy and 3 months post-surgery for the test group (diseased implants) and at baseline and the 3-month evaluation for the control group (healthy implants). Microbial analysis was performed for the detection and quantification of 5 periopathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Fusobacterium nucleatum and Campylobacter rectus) using quantitative real-time polymerase chain reaction.
Results: Plaque index remained low in both groups during the study period. Following non surgical step, therapy endpoints were not reached for any of the diseased implants. At the 6 week re-evaluation, no differences in mean microbial counts for the investigated microbial species were found compared to baseline levels. 3 months after surgical therapy, both groups exhibited statistically significant improvements in clinical measurements. The median PPD reduction (ΔPPD) in both groups was 1.3 mm from a pre-surgical value of 5.7 mm and 5.3 mm for AFL and IPP, respectively. A decrease in bleeding scores in terms of MBI, %BoP and number of sites per implant with BoP, and a decrease in SoP was also recorded, without significant differences between the groups. Short-term treatment success (defined as PPD≤ 5 mm, up to 1 site with MBI score 1, absence of SoP) was obtained in 52.63% of all implants (10/19 implants) and accounted to 5/10 in the AFL and 5/9 implants in the IPP group. At the 3-month follow-up, both surgical interventions significantly reduced P. gingivalis and T. forsythia counts compared to the 6-weeks reevaluation. Additionally, a significant decrease in F. nucleatum counts was observed only after IPP. However, no significant intergroup differences were found. Post-treatment mean counts of red complex bacteria and P.intermedia of both groups and C.rectus only for the AFL group, were at comparable levels to the heathy control group. No adverse events were noted. Patient satisfaction was high in both groups, although patients in the AFL group reported a statistically significant increased sensation of swelling during the first week following surgical debridement.
Conclusions: Within the limitations of the short term observation period and the small sample size, both surgical decontamination protocols seem to significantly and equally improve peri-implant clinical parameters at the 3-month follow-up. Following surgical therapy, a shift towards a microbiological profile similar to that of the healthy control group was reported for both intervention groups. Irrespective of the decontamination protocol employed, treatment success is challenging to achieve.
Keywords:
Surgical therapy of peri-implantitis, Implantoplasty, Air-abrasive device, Erythritol powder, Peri-implant microbiota
