Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy—A Randomized Clinical Trial

Abstract

Background: To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. Methods: In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Results: Thirty-two patients were treated. BOP was more reduced (p = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced (p = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). Conclusions: During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.

Matrix Metalloproteinase-8 as an Inflammatory and Prevention Biomarker in Periodontal and Peri-Implant Diseases

“…Significant correlations have been found between aMMP-8 and progressing severity of periodontal and peri-implant diseases [ 3 , 4 , 6 , 7 , 26 ]. Successful periodontal and peri-implant treatment significantly reduces aMMP-8 levels in oral fluids [ 3 , 6 , 7 , 17 , 78 , 79 ].…”

“…Ramseier et al reported a positive correlation between MMP-8, PI, and BOP in both GCF and PISF [ 65 ]. Ziebolz et al have demonstrated that PISF aMMP-8 levels can be kept successfully low during maintenance in patients undergoing successfully supportive implant therapy indicating that successful professional maintenance intervention is associated with low (<20 ng/ml) PISF aMMP-8 levels similar to the healthy peri-implant status [ 73 , 78 , 79 ]. Similar clinical parameters and MMP-8 levels were obtained with both zirconium and titanium abutments at the end of 1 year.…”

Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis

“…Dental water jet rinse mixed with chlorhexidine gel might supplement the response to nonsurgical treatment for peri-implantitis in a short term by reducing PPD [32]. Studies have found that repeated chlorhexidine chips application might resolve marginal peri-implant in ammation in terms of BOP better than chlorhexidine gel, and PPD was more reduced with 0.65 ± 0.40 mm [30,38]. The e cacy of a single dose is limited, repeated application of local drugs can prolong the effectiveness.…”

Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis

“…Dental water jet rinse mixed with chlorhexidine gel might supplement the response to non-surgical treatment for periimplantitis lesions by reducing the PPD [32]. Some studies demonstrated that repeated application of chlorhexidine chips might resolve the marginal peri-implant inflammation in terms of BOP better than that by chlorhexidine gel, and the PPD was also reduced 0.65 ± 0.40 mm [30,38]. The efficacy of a single dose is limited, but the repeated application of local drugs can prolong the effectiveness.…”