Non-surgical peri-implantitis treatment with or without systemic antibiotics: a randomized controlled clinical trial.
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ABSTRACT: Objectives
To assess the adjunctive effect of systemic amoxicillin (AMX) and metronidazole (MTZ) in patients receiving non-surgical treatment (NST) for peri-implantitis (PI).Materials and methods
Thirty-seven patients were randomized into an experimental group treated with NST plus AMX + MTZ (N = 18) and a control group treated with NST alone (N = 19). Clinical parameters were evaluated at 12 weeks post-treatment. The primary outcome was the change in peri-implant pocket depth (PIPD) from baseline to 12 weeks, while secondary outcomes included bleeding on probing (BoP), suppuration on probing (SoP), and plaque. Data analysis was performed at patient level (one target site per patient).Results
All 37 patients completed the study. Both groups showed a significant PIPD reduction after NST. The antibiotics group showed a higher mean reduction in PIPD at 12 weeks, compared with the control group (2.28 ± 1.49 mm vs. 1.47 ± 1.95 mm), however, this difference did not reach statistical significance. There was no significant effect of various potential confounders on PIPD reduction. Neither treatment resulted in significant improvements in BoP at follow-up; 30 of 37 (81%) target sites still had BoP after treatment. Only two implants, one in each group, exhibited a successful outcome defined as PIPD < 5 mm, and absence of BoP and SoP.Conclusions
Non-surgical treatment was able to reduce PIPD at implants with PI. The adjunctive use of systemic AMX and MTZ did not show statistically significant better results compared to NST alone. NST with or without antibiotics was ineffective to completely resolve inflammation around dental implants.
SUBMITTER: Polymeri A
PROVIDER: S-EPMC9314590 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundA variety of interventions have been explored in the non-surgical management of peri-implantitis. In spite of extensive testing of various study protocols, effective treatments largely remain unavailable. The objective of the present 12-month single-centre, examiner-masked, randomized controlled clinical trial was to explore whether a low-abrasive erythritol air-polishing system produces added clinical benefit when used adjunctive to conventional non-surgical management of peri-implantitis and to record any associated patient-centered outcomes.MethodsForty-three patients with mild to severe peri-implantitis including at least one implant either received ultrasonic/curette subgingival instrumentation and erythritol air-polishing (test) or ultrasonic/curette instrumentation only (control) at baseline and at 3, 6, 9, and 12 months. Probing depth (PD), bleeding on probing (BoP), dental plaque, suppuration (SUP), crestal bone level (CBL), and peri-implant crevicular fluid (PCF) were recorded at baseline, 6 and 12 months. Visual Analogue Scale (VAS) scores were collected immediately following subgingival interventions at all time-points.ResultsA reduction in PD was observed from baseline to 6 months for the test (p = 0.006) and control (p < 0.001) and from baseline to 12 months for the control (p < 0.001). No intergroup differences were observed for primary outcome variables PD or CBL over time (p > 0.05). At 6 months, a intergroup difference in PCF was observed in favor of the test (p = 0.042). Moreover, a reduction in SUP from baseline to 6 and 12 months was observed in the test (p = 0.019). Overall, patients in the control group experienced less pain/discomfort compared with the test (p < 0.05), females reporting more pain/discomfort than males (p = 0.005).ConclusionsThis study confirms that conventional non-surgical management of peri-implantitis produces limited clinical improvement. It is shown that an erythritol air-polishing system may not produce added clinical benefits when used adjunctive to conventional non-surgical management. In other words, neither approach effectively resolved peri-implantitis. Moreover, the erythritol air-polishing system produced added pain/discomfort particularly in female patients.Trial registrationThe clinical trial was prospectively registered in ClinicalTrials.gov with registration NCT04152668 (05/11/2019).
| S-EPMC10125257 | biostudies-literature
Project description:ObjectivesTo compare erythritol air polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis.Material and methodsEighty patients (n = 139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5 mm, marginal bone loss (MBL) ≥2 mm as compared to bone level at implant placement, bleeding, and/or suppuration on probing (BoP/SoP)) were randomly allocated to air polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens, and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9, and 12 months. Differences between both groups were analyzed using multilevel statistics.ResultsThree months after therapy, no significant difference in mean BoP (%) between the air polishing and ultrasonic therapy was found (crude analysis β (95% CI) -0.037 (-0.147; 0.073), p = .380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%), and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score airpolishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = .222). All successfully treated patients at T3 (18.4%) were still considered successful at 12-month follow-up.ConclusionsErythritol air polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical, and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantitis. Hence, the majority of patients required further surgical treatment.
| S-EPMC8360148 | biostudies-literature
Project description:ObjectiveTo evaluate the potential benefit of the use of a bone substitute material in the reconstructive surgical therapy of peri-implantitis.MethodsIn this multicenter randomized clinical trial, 138 patients (147 implants) with peri-implantitis were treated surgically, randomized by coin toss to either a control (access flap surgery) or a test group (reconstructive surgery using bone substitute material). Clinical assessments, including probing pocket depth (PPD), bleeding and suppuration on probing (BOP & SOP) as well as soft tissue recession (REC), were recorded at baseline, 6 and 12 months. Marginal bone levels (MBL), measured on intra-oral radiographs, and patient-reported outcomes (PROs) were recorded at baseline and 12 months. No blinding to group allocation was performed. The primary outcome at 12 months was a composite measure including (i) implant not lost, (ii) absence of BOP/SOP at all aspects, (iii) PPD ≤5 mm at all aspects and (iv) ≤1 mm recession of mucosal margin on the buccal aspect of the implant. Secondary outcomes included (i) changes of MBL, (ii) changes of PPD, BOP%, and buccal KM, (iii) buccal REC and (iv) patient-reported outcomes.ResultsDuring follow-up, four implants (one in the test group, three in the control group) in four patients were removed due to disease progression. At 12 months, a total of 69 implants in the test and 68 implants in the control group were examined. Thus, 16.4% and 13.5% of implants in the test and control group, respectively, met all predefined criteria of the composite outcome. PPD reduction and MBL gain were 3.7 mm and about 1.0 mm in both groups. Reduction in mean BOP% varied between 45% (test) and 50% (control), without significant differences between groups. Buccal REC was less pronounced in the test group (M = 0.7, SD = 0.9 mm) when compared to controls (M = 1.1, SD = 1.5 mm). PROs were favorable in both groups without significant differences. One case of allergic reaction to the antibiotic therapy was recorded. No other adverse events were noted.ConclusionsSurgical therapy of peri-implantitis effectively improved the clinical and radiographic status at 12 months. While the use of a bone substitute material did not improve reductions of PPD and BOP, buccal REC was less pronounced in the test group. Patient satisfaction was high in both groups.
| S-EPMC9544523 | biostudies-literature
Project description:ObjectivesTo compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri-implantitis.Material and methodsDuring a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline-soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow-up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full-mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann-Whitney U test.ResultsNo differences between the test and control group were found for BoP over 12 months of follow-up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1-year follow-up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%).ConclusionsErythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri-implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success.Trial registryhttps://www.trialregister.nl/ Identifier: NL8621.
| S-EPMC9299917 | biostudies-literature
Project description:BackgroundMicrobial biofilm accumulation is the main cause of peri-implantitis. The majority of surgical peri-implantitis treatment protocols suggests adjunctive use of systemic antibiotics to target specific putative bacteria. The aim of this systematic review was to critically evaluate the adjunctive use of systemically administered antibiotics in surgical treatment of peri-implantitis by reviewing previously published systematic reviews and primary studies.MethodsA systematic literature search was conducted in four electronic databases (MEDLINE, The Cochrane Library, EMBASE, and Web of Science) for randomised controlled trials, cohort studies, case-control studies, and systematic reviews reporting surgical treatment of peri-implantitis with and without adjunctive systemically administered antibiotic therapy. The included systematic reviews and primary studies were qualitatively assessed using AMSTAR and GRADE, respectively. No restrictions were set for date of publication, journal, or language.ResultsThe literature search identified 681 papers. Only seven systematic reviews and two primary studies met the inclusion criteria. Four out of seven included systematic reviews concluded that no evidence exists for use of systemic antibiotics to improve the clinical outcomes in surgical treatment of peri-implantitis. One review did not estimate the level of evidence, one did not clearly state any beneficial effect, whereas one reported a limited adjunctive effect. Further, the two included primary studies did not show a long-term significant benefit of adjunctive use of systemically administrated antibiotics. However, one study reported a short-term adjunctive effect in patients with modified surface implants. Due to heterogeneity in study design, low number of included primary studies, and grade of bias, no meta-analysis was performed.ConclusionThe use of systemically administered antibiotics as an adjunct to surgical interventions of peri-implantitis cannot be justified as a part of a standard treatment protocol. A pervasive problem is the lack of uniform diagnosis criteria for peri-implantitis, deficient information about patient characteristics, absence of high quality long-term randomised controlled trials, and authors' declaration on conflict of interest.
| S-EPMC8711198 | biostudies-literature
Project description:ObjectivesThe objective of this study is to investigate the outcomes following non-surgical therapy of peri-implantitis (PI) with or without adjunctive diode laser application.Materials and methodsA double-blinded randomized controlled clinical trial was carried out in 25 subjects with 25 implants diagnosed with PI. Following curettage of granulation tissue, test implants (T) were treated with adjunctive application of a diode laser for 90 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms), while at control implants (C) non-activated adjunctive diode laser was applied. The entire treatment procedure was performed at days 0 (i.e., baseline), 7 and 14. The primary outcome measure was change in mean pocket probing depth (PPD). Clinical and microbiological outcomes, as well as host-derived inflammatory markers were evaluated at baseline, 3 and 6 months, while radiographic outcomes were assessed at baseline and at the 6-month follow-up.ResultsNo statistically significant differences with respect to baseline patient characteristic were observed. After 6 months, both test and control implants yielded statistically significant PPD changes compared with baseline (T: 1.28 and C: 1.47 mm) but without statistically significant difference between groups (p = .381). No statistically significant changes in peri-implant marginal bone levels were detected (p = .936). No statistically significant differences between test and control implants were observed with respect to microbiological and host-derived parameters (p > .05). At the 6-month follow-up, treatment success was observed in 41.7% (n = 5) of test and 46.2% (n = 6) of control patients, respectively (p = .821).ConclusionRepeated adjunctive application of diode laser in the non-surgical management of PI failed to provide significant benefits compared with mechanical instrumentation alone.
| S-EPMC9546299 | biostudies-literature
Project description:AimThe aim of this single-blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non-surgical treatment of peri-implantitis.Material and methodsPatients (N = 62) with peri-implantitis were randomly assigned to receive full-mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T0 ) to 3-month follow-up (T3 ). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis.Results57 patients with 122 implants completed 3-month follow-up. Both groups showed major clinical improvements at T3 in both peri-implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters.ConclusionsSystemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non-surgical peri-implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full-mouth non-surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri-implantitis treatment phase.
| S-EPMC8251966 | biostudies-literature
Project description:PurposeThis retrospective study evaluated the relationship between the timing of peri-implantitis diagnosis and marginal bone level after a 5-year follow-up of non-surgical peri-implantitis treatment.MethodsThirty-three patients (69 implants) were given peri-implantitis diagnosis in 2008-2009 in Seoul National University Bundang Hospital. Among them, 31 implants from 16 patients were included in this study. They were treated non-surgically in this hospital, and came for regular maintenance visits for at least 5 years after peri-implantitis treatment. Radiographic marginal bone levels at each interval were measured and statistical analysis was performed.ResultsTiming of peri-implantitis was one of the significant factors affecting initial bone loss and total bone loss not additional bone after peri-implantitis diagnosis. Patients with cardiovascular disease and diabetic mellitus were positively influenced on both initial bone loss and total bone loss. Patients who needed periodontal treatment after implant placement showed a negative effect on bone loss compared to those who needed periodontal treatment before implant placement during entire periods. Implant location also significantly influenced on amounts of bone loss. Mandibular implants showed less bone loss than maxillary implants. Among surgical factors, combined use of autogenous and xenogenic bone graft materials showed a negative effect on bone loss compared to autogenous bone graft materials. Use of membrane negatively affected on initial bone loss but positively on additional bone loss and total bone loss. Thread exposure showed positive effects on initial bone loss and total bone loss.ConclusionsEarly peri-implantitis diagnosis led to early non-surgical intervention for peri-implantitis treatment, which resulted in the maintenance of the bone level as well as preservation of the implant.
| S-EPMC4485064 | biostudies-literature
Project description:AimThe present multi-centre randomized clinical trial with 12 months of follow-up aimed at studying the added effect of sub-marginal instrumentation before surgical treatment of peri-implantitis.Materials and methodsForty-two patients diagnosed with peri-implantitis were recruited. After a behavioural intervention phase including oral hygiene instructions, patients were randomized to either receiving supra- and sub-marginal instrumentation on their affected implants (control group: 21 patients and 29 implants) or only supra-marginal instrumentation (test group: 21 patients and 24 implants), before undergoing surgery. Changes in the deepest probing pocket depth (PPD) with respect to baseline and a composite outcome of treatment success (no implant loss, no bone loss > 0.5 mm, no bleeding or suppuration on probing [BoP/SoP], and PPD ≤ 5 mm) at the 12-month examination were regarded as the primary outcomes of the trial.ResultsAt the 12-month examination, changes in the deepest PPD with respect to baseline amounted to -2.96 mm in the control group and to -3.11 mm in the test one (MD = -0.16; SE = 0.56; p = .769), while 21.4% of the implants in the control group and 33.3% in the test group presented treatment success (OR = 1.83; SE = 1.15; p = .338). With the exception of a longer non-surgical treatment duration in the control group (differences in = -14.29 min; SE = 2.91; p < .001), no other secondary (e.g., soft-tissue recession, keratinized mucosa height, and bone level changes, as well as BoP, SoP, profuse bleeding and implant loss rates) or exploratory (i.e., early wound healing, aesthetics, surgical and total treatment duration, surgery difficulty, intra-operative bleeding, and adverse events) outcome demonstrated statistically significant differences between groups.ConclusionsThe present multi-centre randomized clinical trial did not demonstrate an added effect of performing sub-marginal instrumentation 6 weeks before the surgical treatment of peri-implantitis. Larger clinical trials are however needed to confirm the present findings (Clinicaltrials.gov: NCT03620331).
| S-EPMC9826024 | biostudies-literature
Project description:The aim of the present study was to evaluate the effect on peri-implant mucosal inflammation from the use of a novel instrument made of chitosan in the non-surgical treatment of mild peri-implantitis across several clinical centers.In this 6-month multicenter prospective consecutive case series performed in six different periodontal specialist clinics, 63 implants in 63 patients were finally included. The subjects had mild peri-implantitis defined as radiographic bone loss of 1-2 mm, pocket probing depth (PPD) ≥4 mm and a positive bleeding on probing (mBoP) score. The patients were clinically examined at baseline and after 2, 4, 12 and 24 weeks, and radiographs were taken at baseline and at 3 and 6 months. Treatment of the implants with the chitosan brush seated in an oscillating dental drill piece was performed at baseline and at 3 months. Reductions in the clinical parameters (PPD and mBoP) were compared between baseline and the later examination time points.Significant reductions in both PPD and mBoP were observed at all time points compared with the baseline clinical measurements (p < 0.001). The mean PPD and mBoP at baseline were 5.15 mm (4.97; 5.32) and 1.86 (1.78; 1.93), respectively, whereas the mean PPD and mBoP at 6 months were 4.0 mm (3.91; 4.19) and 0.64 (0.54; 0.75), respectively. Stable reductions in PPD and mBoP were evident up to 6 months after the initial treatment and 3 months after the second treatment. All 63 implants were reported to have stable radiographic levels of osseous support.This case series demonstrated that an oscillating chitosan brush is safe to use and seems to have merits in the non-surgical treatment of dental implants with mild peri-implantitis. To measure the effectiveness of the method, a multicenter randomized clinical trial needs to be undertaken.
| S-EPMC5543013 | biostudies-other