Treatment of peri‐implantitis using multiple applications of chlorhexidine chips: a double‐blind, randomized multi‐centre clinical trial

Abstract

Background: Universal strategies for managing peri-implantitis are yet to be adopted. The aim of this study is to examine a protocol of intensive application of chlorhexidine containing chips in sites with peri-implantitis. Materials and Methods: This multi-centre, randomized, double-blind, parallel, two-arm clinical trial included 60 patients (77 implants) with probing depth (PD) 6-10 mm and bone loss ! 2 mm around 1-2 implants. One to two weeks following SRP, baseline measurements were made followed by implants' debridement. Patients were randomized to receive matrix chips (MatrixC) or chlorhexidine Chips (PerioC). Measurements and chips placement were repeated at weeks 2, 4, 6, 8, 12 and 18. At 6 months, patients returned for final examination. Results: Probing depth reduction was greater in the PerioC (2.19 ± 0.24 mm) compared with MatrixC (1.59 ± 0.23 mm), p = 0.07. Seventy percentage of the implants in the PerioC and 54% in the MatrixC had PD reduction ! 2 mm. Likewise, 40% of the sites (PerioC) and 24% (MatrixC) had PD reduction ! 3 mm. Clinical attachment level gains for both groups were significant; however, the changes in the PerioC group were significantly greater than in MatrixC [2.21 ± 0.23 mm. and 1.56 ± 0.25 mm respectively, p = 0.05]. Bleeding on probing was reduced by half in both groups. Conclusion: Frequent placement of PerioC and MatrixC together with implants debridement resulted in a substantial improvement in sites with peri-implantitis. Further studies will be required to fully appreciate the mechanism of this treatment.

Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis

“…However, the reference points (i.e. baseline radiographs) and thresholds used to identify bone level changes were either not specified [23–25] or exhibited large variations [26–34]. Radiographic bone level changes as treatment outcome were merely assessed in three studies [28–30].…”

“…In particular, a CHX containing matrix was repeatedly applied at 2, 4, 6, 8, 12 and 18 weeks until PD was reduced to ≤5 mm. At 6 months, CHX chips resulted in a significantly higher PD reduction than the placebo chips [23]. …”

“…The weighted mean (WM) BOP and PD reductions following conventional nonsurgical treatment (referring to the control groups in respective studies) [23–27] amounted to 31.12 % [SE = 9.14; 95 % CI (12.20, 49.05)] and 0.71 mm [SE = 0.32; 95 % CI (0.07, 1.35)], respectively. The weighted mean (WM) BOP and PD reductions for alternative/adjunctive measures (i.e.…”

“…The weighted mean (WM) BOP and PD reductions for alternative/adjunctive measures (i.e. air polishing, aPDT, CHX chip, doxycycline, Er:YAG laser) [23–27] amounted to 42.85 % [SE = 9.24; 95 % CI (24.70, 60.97)] and 0.87 mm [SE = 0.29; 95 % CI (0.29, 1.44)], respectively.…”

Cureent Treatment Modalities for Peri-Implant Diseases.

“…This novel approach of repeated placement of chlorhexidine chips has resulted in a significant improvement of the peri-implant soft tissue parameters six months postop: pocket reduction (mean 2.29 mm) and attachment level gain (2.21 mm) were significantly better than those previously reported for nonsurgical treatment of peri-implantitis. 15 However,Renvert et al did not obtain significant improvement in pocket reduction on repeated subgingival application of minocycline microspheres (Arestin) once a month for up to three months. They have obtained mean pocket reduction in the deepest sites to 0.9mm in the experimental group.…”