Reconstruction of Peri-implant Osseous Defects

Abstract

There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD ≤4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

Surgical Regenerative Treatments for Peri-Implantitis: Meta-analysis of Recent Findings in a Systematic Literature Review

“…Eight prospective clinical studies [22,23,28,29,34,36,38,39], seven case series [24-27,30,33,35], and three randomized clinical trials (RCTs) [31,32,37] were included for the final review. A total of 528 patients (713 implants) were treated.…”

“…Eight studies included rough surface dental implants [26,29,30,31,32,35,37,39], three studies investigated machined surface implants [23,24,36] and five studies - both rough and machined surface dental implants [22,25,27,28]. The remaining two studies did not reveal implant surface specifications [33,38].…”

Peri-Implant Diseases: Peri-implant Mucositis And Peri-implantitis

“…78 Rejeneratif tedavi sırasında implant yüzeyi titanyumdan yapılmış özel küretler ve/veya titanyum fırçalar yardımıyla temizlenir. 56 Jepsen ve arkadaşlarının 79 2016'da yayımladıkları araştırmalarında peri-implantitisten etkilenmiş çanak şeklinde kemik defekti olan 33 implanta önce titanyum fırça ve hidrojen peroksit ile yüzey dekontaminasyonu, ardından titanyum greft uygulanmıştır. Araştırıcılar bu teknik ile, sadece açık flep operasyonuna göre önemli miktarda kemik dolumu izlendiğini bildirmişlerdir 79 .…”

“…56 Jepsen ve arkadaşlarının 79 2016'da yayımladıkları araştırmalarında peri-implantitisten etkilenmiş çanak şeklinde kemik defekti olan 33 implanta önce titanyum fırça ve hidrojen peroksit ile yüzey dekontaminasyonu, ardından titanyum greft uygulanmıştır. Araştırıcılar bu teknik ile, sadece açık flep operasyonuna göre önemli miktarda kemik dolumu izlendiğini bildirmişlerdir 79 . İmplant yüzey dekontaminasyonu için sitrik asit, klorheksidin, tetrasiklin, hidroklorik asit, kloramin, sodyum klorid ya da hidrojenperoksit, gibi maddeler kullanılmaktadır.…”

Tooth Loss and Dental Implant Outcomes—Where is dentistry going? A Survey by SIdP, the Italian Society of Periodontology and Implantology

“…This survey showed also that 59% of subjects replaced extracted teeth with a prosthesis (43% with fixed prosthesis and 16% with removable) and very often dental implants were used (46% of patients with prosthesis, 60% when considering fixed prosthesis only). The overall number of placed implants implant-oriented modern dentistry, although data provided by clinical research reported high prevalence of peri-implant complications (Derks et al, 2016) and relative low predictability of peri-implantitis treatment (Jepsen et al, 2016). Conversely, several long-term studies showed high efficacy of dental treatments, leading to predictable long-term tooth retention (Axelsson, Nystrom, & Lindhe, 2004;Carnevale, Cairo, & Tonetti, 2007;Fonzar, Fonzar, Buttolo, Worthington, & Esposito, 2009;Salvi et al, 2014).…”