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BackgroundPeri‐implantitis poses a significant challenge in dental implantology due to its potential to result in the loss of supporting tissue around dental implants. Surgical reconstruction is often recommended for intrabony defects, accompanied by various adjunctive therapies, such as antimicrobial photodynamic therapy (aPDT), for bacterial decontamination. However, the long‐term efficacy of such treatments remains unclear.MethodsThis clinical report presents a case of peri‐implantitis management in a healthy 55‐year‐old male using guided bone regeneration principles and surface decontamination via aPDT. The patient exhibited peri‐implantitis with probing pocket depths (PPD) of 7 mm at buccal sites, 5 mm at palatal sites, and significant bone loss around implant #12. The reconstructive approach involved preservation of the existing implant and following a non‐submerged healing protocol. The surgical phase included meticulous debridement, chemical detoxification with hydrogen peroxide, and aPDT using a 670 nm diode laser with methylene blue as the photosensitizer. Xenogenic bone graft and a resorbable collagen membrane were applied and the patient was followed up to through a 5‐year period.ResultsPostsurgery the patient exhibited normal healing, and long‐term follow‐up at 5 years showed reduced PPD (2 mm buccally, 3 mm mid‐palatally), complete intrabony defect fill, and stable bone levels, indicating successful treatment.ConclusionsThis case report demonstrates the potential long‐term success of a reconstructive approach with adjunctive aPDT in peri‐implantitis management. However, it highlights the need for standardized protocols and further clinical trials to establish the clinical benefits of aPDT in surgical reconstruction of peri‐implantitis defects, serving as valuable pilot data for future research.HighlightsWhy is this case new information? Provides a rare 5‐year insight into peri‐implantitis intrabony defect reconstruction, offering extended success and outcomes not frequently documented. Demonstrates the efficacy of aPDT with a 670‐nm diode laser in achieving successful long‐term outcomes, contributing valuable evidence to existing literature.Keys to successful management of this case: Success involves initial non‐surgical debridement followed by a reconstructive strategy, incorporating guided bone regeneration and surface decontamination via aPDT. Long‐term success hinges on patient compliance with routine oral hygiene, emphasizing the importance of adherence to preventive measures post‐reconstruction to minimize recurrence risk.What are the primary limitations to success in this case? Variability in photosensitizer uptake, and potential risks such as tissue damage and bacterial resistance pose challenges to the effectiveness of aPDT. The existing literature on aPDT in peri‐implantitis treatment lacks standardization in methodology, laser parameters, and follow‐up durations, making it challenging to establish a universally accepted protocol.
BackgroundPeri‐implantitis poses a significant challenge in dental implantology due to its potential to result in the loss of supporting tissue around dental implants. Surgical reconstruction is often recommended for intrabony defects, accompanied by various adjunctive therapies, such as antimicrobial photodynamic therapy (aPDT), for bacterial decontamination. However, the long‐term efficacy of such treatments remains unclear.MethodsThis clinical report presents a case of peri‐implantitis management in a healthy 55‐year‐old male using guided bone regeneration principles and surface decontamination via aPDT. The patient exhibited peri‐implantitis with probing pocket depths (PPD) of 7 mm at buccal sites, 5 mm at palatal sites, and significant bone loss around implant #12. The reconstructive approach involved preservation of the existing implant and following a non‐submerged healing protocol. The surgical phase included meticulous debridement, chemical detoxification with hydrogen peroxide, and aPDT using a 670 nm diode laser with methylene blue as the photosensitizer. Xenogenic bone graft and a resorbable collagen membrane were applied and the patient was followed up to through a 5‐year period.ResultsPostsurgery the patient exhibited normal healing, and long‐term follow‐up at 5 years showed reduced PPD (2 mm buccally, 3 mm mid‐palatally), complete intrabony defect fill, and stable bone levels, indicating successful treatment.ConclusionsThis case report demonstrates the potential long‐term success of a reconstructive approach with adjunctive aPDT in peri‐implantitis management. However, it highlights the need for standardized protocols and further clinical trials to establish the clinical benefits of aPDT in surgical reconstruction of peri‐implantitis defects, serving as valuable pilot data for future research.HighlightsWhy is this case new information? Provides a rare 5‐year insight into peri‐implantitis intrabony defect reconstruction, offering extended success and outcomes not frequently documented. Demonstrates the efficacy of aPDT with a 670‐nm diode laser in achieving successful long‐term outcomes, contributing valuable evidence to existing literature.Keys to successful management of this case: Success involves initial non‐surgical debridement followed by a reconstructive strategy, incorporating guided bone regeneration and surface decontamination via aPDT. Long‐term success hinges on patient compliance with routine oral hygiene, emphasizing the importance of adherence to preventive measures post‐reconstruction to minimize recurrence risk.What are the primary limitations to success in this case? Variability in photosensitizer uptake, and potential risks such as tissue damage and bacterial resistance pose challenges to the effectiveness of aPDT. The existing literature on aPDT in peri‐implantitis treatment lacks standardization in methodology, laser parameters, and follow‐up durations, making it challenging to establish a universally accepted protocol.
Bone defect repair involves a series of dynamic and complex processes, including immunoregulation, angiogenesis, and osteogenesis. Herein, a phased bioactive ions‐oriented release strategy is proposed to construct the bilayer Cu&Sr‐hydroxyapatite (HAp)/polylactic acid (CSHP‐)guided bone regeneration membrane. By harnessing distinct modes of ion delivery, Cu2+ adsorbed on the surface can be released quickly from the CSHP membrane to trigger a cascade of events including antibacterial reaction, regulating macrophage polarization, and enhancing angiogenesis. With the gradual degradation of HAp, Sr2+ doped in the lattice is sustainably released, synergistically regulating immunity, and encouraging the genesis of robust skeletal tissue. The bilayer structure of the CSHP membrane also ensures the oriented release of bioactive ions to the bone defect area, circumventing any systemic complications that might arise from indiscriminate dispersal. Furthermore, the nanoengineered HAp layer deters pathogenic colonization due to the low adhesion force, which can effectively prevent the formation of bacterial biofilms and infection after implantation. Overall, the multifunctional bilayer CSHP membrane, based on the phased and oriented ions release, adapts to the dynamic requirements of bone repair, thereby augmenting regeneration efficiency, and also providing a reference for the design of advanced repair materials.
Background Biological-derived hydroxyapatite is widely used as a bone substitute for addressing bone defects, but its limited osteoconductive properties necessitate further improvement. The osteo-immunomodulatory properties hold crucial promise in maintaining bone homeostasis, and precise modulation of macrophage polarization is essential in this process. Metabolism serves as a guiding force for immunity, and fluoride modification represents a promising strategy for modulating the osteoimmunological environment by regulating immunometabolism. In this context, we synthesized fluorinated porcine hydroxyapatite (FPHA), and has demonstrated its enhanced biological properties and osteogenic capacity. However, it remains unknown whether and how FPHA affects the immune microenvironment of the bone defects. Methods FPHA was synthesized and its composition and structural properties were confirmed. Macrophages were cultured with FPHA extract to investigate the effects of FPHA on their polarization and the related osteo-immune microenvironment. Furthermore, total RNA of these macrophages was extracted, and RNA-seq analysis was performed to explore the underlying mechanisms associated with the observed changes in macrophages. The metabolic states were evaluated with a Seahorse analyzer. Additionally, immunohistochemical staining was performed to evaluate the macrophages response after implantation of the novel bone substitutes in critical size calvarial defects in SD rats. Results The incorporation of fluoride ions in FPHA was validated. FPHA promoted macrophage proliferation and enhanced the expression of M2 markers while suppressing the expression of M1 markers. Additionally, FPHA inhibited the expression of inflammatory factors and upregulated the expression of osteogenic factors, thereby enhancing the osteogenic differentiation capacity of the rBMSCs. RNA-seq analysis suggested that the polarization-regulating function of FPHA may be related to changes in cellular metabolism. Further experiments confirmed that FPHA enhanced mitochondrial function and promoted the metabolic shift of macrophages from glycolysis to oxidative phosphorylation. Moreover, in vivo experiments validated the above results in the calvarial defect model in SD rats. Conclusion In summary, our study reveals that FPHA induces a metabolic shift in macrophages from glycolysis to oxidative phosphorylation. This shift leads to an increased tendency toward M2 polarization in macrophages, consequently creating a favorable osteo-immune microenvironment. These findings provide valuable insights into the impact of incorporating an appropriate concentration of fluoride on immunometabolism and macrophage mitochondrial function, which have important implications for the development of fluoride-modified immunometabolism-based bone regenerative biomaterials and the clinical application of FPHA or other fluoride-containing materials. Graphical Abstract. FPHA was successfully prepared through the chemical and thermal process. The immunomodulatory effects of FPHA were investigated through in vitro and in vivo studies, revealing its ability to induce a metabolic shift in macrophages from glycolysis to mitochondrial oxidative phosphorylation (OxPhos). This metabolic remodeling resulted in a notable suppression of M1 macrophage polarization and promotion of M2 macrophage polarization. Furthermore, FPHA was found to enhance osteogenic differentiation and facilitate bone repair. These findings underscore the promising potential of FPHA as a biomaterial for bone regenerative applications, providing valuable insights for the development of bioactive materials with metabolic-immunoregulatory properties Graphical Abstract
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