Detoxification of Implant Surfaces Affected by Peri-Implant Disease: An Overview of Non-surgical Methods

Abstract

Objective: The aim of this review is to summarize the findings of studies that have evaluated non-surgical approaches for detoxification of implant body surfaces in vitro and in vivo, and to evaluate clinical trials on the use of these methodologies for treating peri-implant disease.Materials and methods: A literature search was conducted using MEDLINE (Pubmed) from 1966 to 2013. In vitro and in vivo studies as well as clinical trials on non-surgical therapy were evaluated. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters including probing depth, clinical attachment levels, bleeding on probing; radiographic bone fill and histological re-osseointegration. Results: From 134 articles found 35 were analyzed. The findings, advantages and disadvantages of using lasers as well as mechanical and chemical methods are discussed. Most of the in vivo and human studies used combination therapies which makes determining the efficacy of one specific method difficult. Most human studies are case series with short term longitudinal analysis without survival or failure reports. Conclusion: Complete elimination of the biofilms is difficult to achieve using these approaches. All therapies induce changes of the chemical and physical properties of the implant surface. Re-osseointegration may be difficult to achieve if not impossible without surgical access to ensure thorough debridement of the defect and detoxification of the implant surface. Combination protocols for non-surgical treatment of peri-implantitis in humans have shown some positive clinical results but long-term evaluation to evaluate the validity and reliability of the techniques is needed.

Probing the nanoadhesion of Streptococcus sanguinis to titanium implant surfaces by atomic force microscopy

“…Disrupting minor-unbinding events between S. sanguinis and Ti with 2 mg/ml chX CHX is one of the most widely used agents for the nonsurgical treatment of infected dental implant surfaces, 6 and it has the property of remaining active for several hours by adsorbing onto surfaces. 38 However, little is known about the effect this substance has on the early adhesive interaction of oral streptococci bacteria with surfaces.…”

“…The increase in adhesion observed after the application of CHX could be explained by two possible mechanisms. First, CHX is a positively charged molecule with the ability to bind to substrates and negatively charged bacterial surfaces, 6 and therefore its presence may increase the binding affinity between the probe and Ti surface. Second, CHX exposure has been shown to alter the mechanical properties of the bacterial cell and cause membrane damage, 38,39 which could also lead to increased adhesion due to increased compliance of the bacterium against the surface during probing.…”

“…2,3 Ti dental implants have shown excellent survival rates in the past years, 4 however, the issue of bacterial colonization remains a problem as biofilm formation on the implant surface can lead to loss of osseointegration with subsequent treatment failure. [5][6][7] Thus, many chemical disinfection protocols have been developed to try and clean implants after surface infection, in hopes of avoiding surgical intervention and increase the survival rates of affected implants. 8 Biofilm formation comprises of a series of stages, starting with the initial adhesion of early colonizing species 9 and continued by the attachment of secondary and increasingly pathogenic bacteria that can lead to disease.…”

Citric acid reduces oral biofilm and influences the electrochemical behavior of titanium: Anin situandin vitrostudy

“…Different antimicrobial agents have been used, but there is no consensus about which is the most suitable chemotherapeutic agent for implant disinfection . Citric acid has been used to decontaminate titanium surfaces covered by biofilm . According to a systematic review, citric acid seems to be the chemical agent with the highest potential for biofilm removal from titanium surfaces .…”

The Use of the Dental Endoscope and Videoscope for Diagnosis and Treatment of Peri‐Implant Diseases

“…While a number of medicaments have been suggested to remove biofilm and its products, at present the author suggests the use of chlorhexidine [4]. Aided by endoscope visualization, as much of the material adherent to the implant as possible should be removed.…”