Clinical, Microbiological and Inflammatory Evidence of the Efficacy of Combination Therapy Including Serratiopeptidase in the Treatment of Periimplantitis

Abstract

The first two authors contributed equally to this workThe present study was aimed to evaluate the effect of introducing administration of the proteolytic enzyme serratiopeptidase in the combined mechanical-antibiotic treatment of periimplantitis (PI). Two randomized groups of 64 adults with a diagnosis of PI were studied over a 6-month period. All patients were treated with a combined mechanical and antibiotic protocol for 15 days. The experimental group (EG) was administered antibiotic and serratiopeptidase, while the control group was administered antibiotic alone. To evaluate the effects of the two treatment protocols, clinical and radiographic indices, the concentration of IL-l p, IL-6 and TNF-a in the gingival crevicular fluid, the amount of total bacterial DNA and the presence of specific bacteria were assessed at baseline and at 6 months from treatment. Success rates of combined treatments at 6 months were 96.9% and 78.1% for the EG and CG respectively (P :::;0.01). Implants of the EG showed greater enhancement of clinical, microbiological and inflammatory parameters as compared to those of the CG. Microbiological analyses showed that resistance to combined therapy was constantly associated with the isolation of bacterial species that are not common periodontal pathogens (mainly S.aureus and P.aeruginosa). The data demonstrate that the addition of serratiopeptidase to combined mechanical-antibiotic treatment protocols of periimplantitis significantly improves outcomes and suggest that serratiopeptidase acts at different levels during the healing process.

Serratiopeptidase Affects the Physiology of Pseudomonas aeruginosa Isolates from Cystic Fibrosis Patients

“…Under this point of view, it’s interesting to understand the effect of SPEP on some physiological aspects of clinical P. aeruginosa strains that are so relevant for the development of chronic infection. Furthermore, the demonstrated ability of SPEP to interfere with the adhesive properties of bacterial pathogens [ 21 , 22 , 23 , 24 ] drives researchers to further investigate its action on other virulence factors.…”

“…In the field of infectious diseases, SPEP is recognized to be effective against a variety of biofilm-associated chronic infections and against adhesion and invasion of bacteria on eukaryotic cells [ 21 , 22 , 23 , 24 ].…”

Combination Therapy Including Serratiopeptidase Improves Outcomes of Mechanical-Antibiotic Treatment of Periimplantitis

“…Basing on these results, we added SPEP to protocols of combined treatment of PI. More recently, we also demonstrated that the combined systemic administration of antibiotics and SPEP associated to mechanical debridement of implant surfaces significantly enhances success rates in the treatment of PI (19). After 15 years of experience we decided to compare clinical outcomes of this potentially improved protocol with those of other colleagues adopting the standard combined protocol that does not include SPEP.…”

Serratiopeptidase: Insights into the therapeutic applications

“…Moreover, commercial proteases have also been successful in the eradication of biofilms [ 46 , 47 ]. Serratiopeptidase, a commercially available bacterial metalloprotease has proven to be effective against a variety of biofilm-associated medical conditions due to the following reasons: It can modify the virulent phenotype of bacteria in biofilms [ 48 , 49 ] It is effective against mature biofilms [ 49 ] It enhances the bactericidal effect of antibiotics against bacterial biofilms [ 50 ]. …”

“…Colonization of bacteria occurs at the surface of the implant, forming a biofim which causes severe inflammation of the peri-implant tissue and damages the implant supporting bone. In a controlled study of 64 adults, [ 50 ] evaluated the combined effect of serratiopeptidase with antibiotics in peri-implantitis. The combined treatment significantly improved clinical, microbiological, and inflammatory parameters as compared to the control group.…”