Repeated delivery of chlorhexidine chips for the treatment of peri‐implantitis: A multicenter, randomized, comparative clinical trial

Abstract

Background Peri‐implantitis is a challenging condition to manage and is frequently treated using non‐surgical debridement. The local delivery of antimicrobial agents has demonstrated benefit in mild to moderate cases of peri‐implantitis. This study compared the safety and efficacy of chlorhexidine gluconate 2.5 mg chip (CHX chips) as an adjunctive treatment to subgingival debridement in patients afflicted with peri‐implantitis. Methods A multicenter, randomized, single‐blind, two‐arm, parallel Phase‐3 study was conducted. Peri‐implantitis patients with implant pocket depths (IPD) of 5‐8 mm underwent subgingival implant surface debridement followed by repeated bi‐weekly supragingival plaque removal and chlorhexidine chips application (ChxC group) for 12 weeks, or similar therapy but without application of ChxC (control group). All patients were followed for 24 weeks. Plaque and gingival indices were measured at every visit whereas IPD, recession, and bleeding on probing were assessed at 8, 12, 16, 24 week. Results A total of 290 patients were included: 146 in the ChxC group and 144 in the control. At 24 weeks, a significant reduction in IPD (P = 0.01) was measured in the ChxC group (1.76 ± 1.13 mm) compared with the control group (1.54 ± 1.13 mm). IPD reduction of ≥2 mm was found in 59% and 47.2% of the implants in the ChxC and control groups, respectively (P = 0.03). Changes in gingival recession (0.29 ± 0.68 mm versus 0.15 ± 0.55 mm, P = 0.015) and relative attachment gain (1.47 ± 1.32 mm and 1.39 ± 1.27 mm, P = 0.0017) were significantly larger in the ChxC group. Patients in the ChxC group that were < 65 years exhibited significantly better responses (P < 0.02); likewise, non‐smokers had similarly better response (P < 0.02). Both protocols were well tolerated, and no severe treatment‐related adverse events were recorded throughout the study. Conclusions Patients with peri‐implantitis that were treated with an intensive treatment protocol of bi‐weekly supragingival plaque removal and local application of chlorhexidine chips had greater mean IPD reduction and greater percentile of sites with IPD reduction of ≥2 mm as compared with bi‐weekly supra‐gingival plaque removal.

Assessment of Disinfection Potential of Q-Switch Nd: YAG Laser on Contaminated Titanium Implant Surfaces

“…Unlike our study, no bacteriological study was made to elucidate the disinfection potential of the suggested approaches. Apart from the use of the laser, additional approaches are being studied to optimize the results of the non-surgical and/or surgical management of PI such as probiotic Lactobacillus Reuteri [36,37]; chlorhexidine is considered as the molecule of choice [14,38].…”

Peri-implant disease: early diagnosis and non-surgical treatment—a narrative literature review

“…For peri-implantitis with alveolar bone loss around the fixture, clinicians should assume that implant fixture surface is heavily contaminated and should use conventional automated and hand scaler to ensure effective removal of dental plaque or biofilm around the contaminated implant fixture (Figure 5) (84). Non-surgical mechanical debridement alone usually provides 20-50% reduction in bleeding on probing and in some cases pocket reduction (≤1 mm) in periimplantitis (74,(85)(86)(87)(88)(89). Thus, in advanced cases, complete resolution of the disease is unlikely and many need adjunctive treatment to improve the magnitude of improvement (74).…”

“…For accessible surface, implantoplasty can be performed using a high speed carbide bur with rigorous water cooling to further remove residual dental plaque and their associated debris and to convert a rough to a smoothened surface, allowing more effective plaque removal during maintenance phase by patients and treating clinicians (56,90,91). Various adjunctive therapeutic modalities in addition to non-surgical therapy were reported utilizing systemic antibiotics, locally delivered antimicrobial, laser, photodynamic therapy, and air polishing; however clinicians should carefully utilize these modalities considering a limited availability of evidence in the literature (74,85,87,88,(92)(93)(94). After non-surgical peri-implant therapy, consisting of home care therapy and professional mechanical debridement, a significant reduction in probing depth to 3-4 mm with resolution of bleeding and suppuration on probing was noted at re-evaluation.…”

Titanium Wear of Dental Implants from Placement, under Loading and Maintenance Protocols

“…Local antibiotics have also been utilized to treat peri-implantitis [29]. Slow release chemotherapeutic devices with chlorhexidine also seem to have a positive impact on reduction of clinical parameters of peri-implant inflammation [67].…”