Background: Universal strategies for managing peri-implantitis are yet to be adopted. The aim of this study is to examine a protocol of intensive application of chlorhexidine containing chips in sites with peri-implantitis. Materials and Methods: This multi-centre, randomized, double-blind, parallel, two-arm clinical trial included 60 patients (77 implants) with probing depth (PD) 6-10 mm and bone loss ! 2 mm around 1-2 implants. One to two weeks following SRP, baseline measurements were made followed by implants' debridement. Patients were randomized to receive matrix chips (MatrixC) or chlorhexidine Chips (PerioC). Measurements and chips placement were repeated at weeks 2, 4, 6, 8, 12 and 18. At 6 months, patients returned for final examination. Results: Probing depth reduction was greater in the PerioC (2.19 ± 0.24 mm) compared with MatrixC (1.59 ± 0.23 mm), p = 0.07. Seventy percentage of the implants in the PerioC and 54% in the MatrixC had PD reduction ! 2 mm. Likewise, 40% of the sites (PerioC) and 24% (MatrixC) had PD reduction ! 3 mm. Clinical attachment level gains for both groups were significant; however, the changes in the PerioC group were significantly greater than in MatrixC [2.21 ± 0.23 mm. and 1.56 ± 0.25 mm respectively, p = 0.05]. Bleeding on probing was reduced by half in both groups. Conclusion: Frequent placement of PerioC and MatrixC together with implants debridement resulted in a substantial improvement in sites with peri-implantitis. Further studies will be required to fully appreciate the mechanism of this treatment.
Endodontic failures associated with poor quality of endodontics respond favorably to retreatment. Nevertheless, under certain clinical conditions, apicoectomy should be the preferred procedure. A retrospective survey of 200 roots that were referred for apical surgery revealed that 83% of the roots were inadequately obturated, including 8.5% with no root canal filling at all. In 49 of the roots in this group (24.5% of the referred cases) nonsurgical retreatment was judged by an endodontist as either impossible or improbable because it might jeopardize the root integrity. Retreatment should have been the preferred treatment modality for the rest of the group, provided that coronal restorations could be safely bypassed or removed. Posts were found in 63 of these teeth, however 35 of them were either short or loosely fitting and could safely be removed. The rest of the posts were longer than 5 mm, which might have presented a problem if their removal was attempted. In 45% of the 200 cases in the present study, surgical intervention was justified. The rest of the cases (55%) should have either been subjected to a follow-up (10.5%) or retreated nonsurgically by a skilled endodontist (44.5%). These results indicate that referring dentists may not appreciate the retreatment possibilities offered by modern endodontics, and they emphasize the need for a shift of concept: endodontists should be involved in the decision making before referring a patient to surgery.
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