Comparison of the effects of air-powder abrasion, chemical decontamination, or their combination in open-flap surface decontamination of implants failed for peri-implantitis: an ex vivo study

Abstract

Objectives To compare, using an ex vivo model, the biofilm removal of three surface decontamination methods following surgical exposure of implants failed for severe peri-implantitis. Materials and methods The study design was a single-blind, randomized, controlled, ex vivo investigation with intra-subject control. Study participants were 20 consecutive patients with at least 4 hopeless implants, in function for >12 months and with progressive bone loss exceeding 50%, which had to be explanted. Implants of each patient were randomly assigned to the untreated control group or one of the three decontamination procedures: mechanical debridement with air-powder abrasion, chemical decontamination with hydrogen peroxide and chlorhexidine gluconate, or combined mechanical-chemical decontamination. Following surgical exposure, implants selected as control were retrieved, and afterwards, test implants were decontaminated according to allocation and carefully explanted with a removal kit. Microbiological analysis was expressed in colony-forming-units (CFU/ml). Results A statistically significant difference (p < 0.001) in the concentrations of CFU/ml was found between implants treated with mechanical debridement (531.58 ± 372.07) or combined mechanical-chemical decontamination (954.05 ± 2219.31) and implants untreated (37,800.00 ± 46,837.05) or treated with chemical decontamination alone (29,650.00 ± 42,596.20). No statistically significant difference (p = 1.000) was found between mechanical debridement used alone or supplemented with chemical decontamination. Microbiological analyses identified 21 microbial species, without significant differences between control and treatment groups. Conclusions Bacterial biofilm removal from infected implant surfaces was significantly superior for mechanical debridement than chemical decontamination. Clinical relevance The present is the only ex vivo study based on decontamination methods for removing actual and mature biofilm from infected implant surfaces in patients with peri-implantitis.

Cross-kingdom microbial interactions in dental implant-related infections: is Candida albicans a new villain?

“…When comparing the colonization in dental implant surfaces versus teeth, fungal species were more frequently identified at peri-implantitis and even health implant sites than at selected teeth in healthy patients, showing the ability of C. albicans to colonize titanium surfaces ( Schwarz et al., 2015 ). Importantly, although C. albicans is the most prevalent and more often described Candida species in peri-implant diseased sites ( Yeh et al., 2019 ; Pranno et al., 2021 ) , with the advantage of new identification techniques, other non-albicans species have been recently identified on peri-implantitis sites such as Candida parapsilosis, Candida tropicalis, and Candida dubliniensis ( Mendoza et al., 2021 ) . Among these, C. albicans and C. dubliniensis are the only polymorphic species, which are able to form hyphae and/or pseudohyphae, creating robust biofilms, while C. parapsilosis and C. tropicalis cannot produce true hyphae, but can form pseudohyphae, depending on growth conditions.…”

Impact of surface decontamination and systemic antimicrobials for surgical treatment of peri-implantitis: A systematic review and meta-analysis of randomized clinical trials

“…53 Removal of bacterial biofilm from contaminated implant surfaces with air-powder abrasion has been reported to provide significantly superior microbiological outcomes than chemical decontamination with hydrogen peroxide and chlorhexidine gluconate. 54 Coupling mechanic instruments with chemical/physical agents may improve the overall cleaning ability as the chemical agent may reach niches inaccessible for the instruments. 12 Numerous chemical decontaminants have been tested, although their efficacy has been difficult to demonstrate.…”

Does Ultraviolet Radiation Exhibit Antimicrobial Effect against Oral Pathogens Attached on Various Dental Implant Surfaces? A Systematic Review

“…However, curettes and ultrasonic devices have failed to obliterate bacterial counts in peri-implantitis [ 6 ]. Furthermore, chemical decontamination with hydrogen peroxide and chlorhexidine gluconate was found to be inferior to mechanical debridement [ 7 ]. The efficacy of antibiotic management is still debatable and depends on implant surface characteristics [ 8 , 9 ].…”