Peri-Implant Bone Resorption during Healing Abutment Placement: The Effect of a 0.20% Chlorhexidine Gel vs. Placebo—A Randomized Double Blind Controlled Human Study

Abstract

Introduction Peri-implant marginal bone loss (MBL) seems to be more pronounced in the first year of loading despite all the studies and changes implemented to reduce it. Among the different causes, the presence of a microgap makes the interface between fixture and abutment colonizable by bacteria, causing an inflammatory response and consequent bone resorption. To reduce this several local antiseptics like chlorhexidine digluconate (CHX) were used after surgical procedures. Aim The objective was to radiologically compare the MBL when a 0.20% CHX gel or a placebo gel was applied to the implant-abutment interface during all surgical and prosthetic phases and for a follow-up period up to 12 months. Method 32 patients (16 for each Group A and B) were enrolled and rehabilitated with a single implant (Cortex classic, Cortex, Shalomi, Israel). During each of the clinical stages a gel containing 0.20% CHX (Plak ®Gel; Polifarma Wellness Srl, Rome, Italy) or a placebo gel (Placebo, Polifarma Wellness Srl, Rome, Italy) was used as indicated by the randomization chart. In order to compare radiographic modification intraoral radiographs was taken. Also, clinical data regarding implant or prosthetic failure and gingival index were recorded. Data were presented as means and standard deviations (SD) and used for the statistical analysis. Results All implants showed no bleeding on probing and a very small plaque score at the 1 year of follow-up. MBL was statistically significantly different between the groups in every stage. Conclusion Results obtained showed that the use of CHX gel inside the connection significantly reduces MBL during the first year. A rigid disinfection protocol with 0.20% CHX from the time of implant insertion to crown delivery is recommended to reduce host inflammatory response and consequently MBL. This trial is registered with ClinicalTrials.gov Identifier: (Registration Number: NCT03431766).

Antiseptic sealant and a nanocoated implant‐abutment interface improve the results of dental implantation

“…To reduce this bone tissue loss, a number of researchers have used similar techniques to those in this study, and obtained comparable results, indicating the promise of this approach. Sinjari et al used chlorhexidine digluconate as a gel, compared against a placebo. The results showed that applied medication significantly reduced bone loss in the first year of using implant‐supported prostheses.…”

Porphyromonas Gingivalis Load is Balanced by 0.20% Chlorhexidine Gel. A Randomized, Double-Blind, Controlled, Microbiological and Immunohistochemical Human Study

“…All patients gave a written informed consent to the treatment and study recruiting. The trial was registered on clinicaltrials.gov with registration number NCT03431766 as previously described [32]. This article was written following the CONSORT statement for improving the quality of randomized controlled trials, RCTs (Figure 1) [37].…”

“…The stages of the study were organized as follows: T0, first surgical stage: implant placement, recording of clinical data and collection of soft tissue biopsies for immunohistochemical analysis (baseline); T1, second surgical stage after 8 weeks: recording of clinical data and collection of soft tissue biopsies for immunohistochemical analysis and insertion of healing abutment; T2, first prosthetic stage (implant impression) at 10 weeks: healing abutment collection for microbiological analysis (for more details see Table 1). The primary outcome of this Randomized Clinical Trial (RCT) was to analyze the marginal bone resorption around dental implants as previously described in details [32]. Meanwhile, the objective of the present paper (the secondary outcome of the RCT) was to investigate by means of a quantitative analysis, the presence of P. gingivalis on the healing abutment when 0.20% CHX gel (Plak Gel; Polifarma Wellness Srl, Rome, Italy) and placebo gel (Placebo, Polifarma Wellness Srl, Rome, Italy) were applied during the first and second surgical stages.…”

“…Radiographs were performed to verify the presence of an adequate dimension of the alveolar ridge. All implants (Cortex classic, Shalomi, Israel) have been inserted at bone crestal level, by two skilled operators who followed a two-stage protocol and placed them according to the manufacturer's instructions as previously described [32,40]. Implants inserted were all of 3.8 and 4.2 mm in diameter, with a mean diameter of 3.98 ± 0.20 mm and mean length of 11.07 ± 0.68 mm.…”

“…Nowadays, several strategies such as chlorhexidine (CHX) gels with different concentrations are used for the maintenance of soft tissue health and/or in the treatment of peri-implantitis. CHX is a local antiseptic usually applied after surgical procedures to reduce bacterial adhesion and biofilm formation on implant abutment surfaces [29][30][31][32][33]. The key role of CHX in inhibiting bacterial plaque formation has been widely confirmed [34,35].…”