Gordon John

Combined surgical therapy of peri‐implantitis evaluating two methods of surface debridement and decontamination. A two‐year clinical follow up report

OBJECTIVES The study aimed at evaluating the 2-year results obtained following combined surgical resective and regenerative treatment of advanced peri-implantitis defects comparing two methods of surface debridement/decontamination (DD). MATERIAL & METHODS Twenty-four patients (n = 26 combined supra- and intrabony defects) completed the 24 months follow-up observation following access flap surgery, granulation tissue removal and implantoplasty at bucally and supracrestally exposed implant parts. The remaining aspects were randomly allocated to surface DD using either (i) an Er:YAG laser (ERL) device, or (ii) plastic curets + cotton pellets + sterile saline (CPS) were augmented with a natural bone mineral and covered with a collagen membrane. RESULTS At 24 months, ERL treated sites failed to reveal significantly higher reductions in mean BOP (ERL: 75.0 ± 32.6% versus CPS: 54.9 ± 30.3%) and CAL values (ERL: 1.0 ± 2.2 mm versus CPS: 1.2 ± 2.2 mm) when compared with the CPS group. In both groups, mean CAL values were not significantly different when compared with baseline. CONCLUSION The long-term stability of clinical outcomes obtained following combined surgical therapy of advanced peri-implantitis may be influenced by factors other than the method of surface debridement/decontamination.

Four‐year follow‐up of combined surgical therapy of advanced peri‐implantitis evaluating two methods of surface decontamination

OBJECTIVES To investigate the impact of two surface decontamination methods on the long-term outcomes following combined surgical resective/regenerative therapy of advanced peri-implantitis lesions. MATERIAL AND METHODS Seventeen patients (n = 17 combined supra- and intrabony-defects) completed the 48 months follow-up observation following access flap surgery, granulation tissue removal and implantoplasty at bucally and supracrestally exposed implant parts. The remaining unmodified implant surface areas were randomly treated using either (i) an Er:YAG laser (ERL), or (ii) plastic curets + cotton pellets + sterile saline (CPS), and augmented with a natural bone mineral + collagen membrane. RESULTS At 48 months, CPS-treated sites tended to reveal higher reductions in mean BOP (CPS: 85.2 ± 16.4% versus ERL: 71.6 ± 24.9%) and CAL values (CPS: 1.5 ± 2.0 mm versus ERL: 1.2 ± 2.0 mm) when compared with the ERL group. In both groups, clinical outcomes were not directly influenced by the initial defect configuration. CONCLUSION The 4-year clinical outcomes obtained following combined surgical resective/regenerative therapy of advanced peri-implantitis were not influenced by the method of surface decontamination.

Modified Implant Surface with Slower and Less Initial Biofilm Formation

Background Peri-implant mucositis and peri-implantitis are a raising issue in dental implantology. Peri-implant infections are mainly caused by the formation of biofilm. Different surface textures exhibit various conditions for biofilm formation resulting in several speed of maturation and development. Materials and Methods On three different titanium implant surfaces, machined-surface (M), sandblasted large grit, and acid-etched surface (SLA) and machined-modified acid-etched surface (mod MA) initial biofilms were collected. Plaque formation was investigated by erythrosine staining and energy-dispersive X-ray spectroscopy (EDX). For testing the biocompatibility of these plaque-settled surfaces, autoclaved specimens were settled with human gingival fibroblasts, and cell viability was tested. Results The mean initial plaque surface was detected in the following descending order: M > SLA > mod MA. The differences between these groups were significant. The highest cell viability was detected in the M groups, whereas mod MA and SLA showed comparable results. The results of initial biofilm formation were proved by EDX. Conclusions Within the limitations of this study, conclusion can be made that mod MA surface shows significant slower initial biofilm formation which could be an advantage in initial transgingival healing process and also an easement for oral hygiene of patients because maturation of plaque is retarded, and immature biofilms are easier to remove.BACKGROUND Peri-implant mucositis and peri-implantitis are a raising issue in dental implantology. Peri-implant infections are mainly caused by the formation of biofilm. Different surface textures exhibit various conditions for biofilm formation resulting in several speed of maturation and development. MATERIALS AND METHODS On three different titanium implant surfaces, machined-surface (M), sandblasted large grit, and acid-etched surface (SLA) and machined-modified acid-etched surface (mod MA) initial biofilms were collected. Plaque formation was investigated by erythrosine staining and energy-dispersive X-ray spectroscopy (EDX). For testing the biocompatibility of these plaque-settled surfaces, autoclaved specimens were settled with human gingival fibroblasts, and cell viability was tested. RESULTS The mean initial plaque surface was detected in the following descending order: M > SLA > mod MA. The differences between these groups were significant. The highest cell viability was detected in the M groups, whereas mod MA and SLA showed comparable results. The results of initial biofilm formation were proved by EDX. CONCLUSIONS Within the limitations of this study, conclusion can be made that mod MA surface shows significant slower initial biofilm formation which could be an advantage in initial transgingival healing process and also an easement for oral hygiene of patients because maturation of plaque is retarded, and immature biofilms are easier to remove.

Effects of taurolidine and chlorhexidine on SaOS-2 cells and human gingival fibroblasts grown on implant surfaces.

PURPOSE The purpose of the study was the evaluation of possible cytologic effects of taurolidine to fibroblasts and osteoblast-like cells. MATERIALS AND METHODS Human gingival fibroblasts and SaOS-2 cells were seeded on samples with sand-blasted and acid-etched surfaces. Both groups were treated with taurolidine, chlorhexidine, and pure water with three different treatment times. Three dates of measurements were set to evaluate cell viability, cytotoxicity, and apoptosis. RESULTS Highest cytotoxicity was measured in both cell lines in the groups treated with chlorhexidine, while cell viability was lower than in the corresponding taurolidine and pure water groups; on days 3 and 6 these differences were significant. Taurolidine showed similar results to the pure water groups. CONCLUSION The results of this study indicate that taurolidine is biocompatible and gentle to the tested human cells for the application time of a mouthrinse.

Combined surgical resective and regenerative therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation: a case report.

This case report presents a 3-year follow-up of the clinical outcomes of a combined surgical therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation using a collagen matrix. One patient suffering from advanced peri-implantitis and a thin mucosal biotype underwent access flap surgery, implantoplasty at buccally and supracrestally exposed implant parts, and augmentation of the intrabony components using a natural bone mineral and a native collagen membrane after surface decontamination. A collagen matrix was applied to the wound area to increase soft tissue volume and support transmucosal healing. The following clinical parameters were recorded over a period of 3 years: bleeding on probing (BOP), probing depth (PD), mucosal recession (MR), clinical attachment level (CAL), and width of keratinized mucosa (KM). At 36 months, the combined surgical procedure was associated with a clinically important reduction in mean BOP (100%), PD (4.3 ± 0.5 mm), and CAL (4.4 ± 0.4 mm). Site-level analysis of the buccal aspects pointed to an increase in MR (-1.0 ± 0.4 mm) and a decrease in KM (-1.3 ± 0.5 mm) values at 12 months. However, a regain in mucosal height and KM was noted at 24 months, even reaching respective baseline values after 36 months of healing. The presented combined surgical procedure was effective in controlling an advanced peri-implantitis lesion without compromising the overall esthetic outcome in the long term.

Reentry After Combined Surgical Resective and Regenerative Therapy of Advanced Peri-implantitis: A Retrospective Analysis of Five Cases.

This retrospective analysis of five reentry cases reports on the clinical defect healing after combined surgical resective/regenerative therapy of advanced peri-implantitis. A second surgery was necessary because of a clinical need for additional treatment procedures at the respective implant sites after healing periods of 8 months to 6.5 years. All patients underwent the same standardized procedure including access flap surgery, implantoplasty at bucally and supracrestally (> 1 mm) exposed implant parts, surface decontamination, and augmentation of the intrabony (Class I) components using a natural bone mineral and a native collagen membrane. Clinical defect resolution (DR) of the Class I component was evaluated. In two patients, clinical and radiographic signs suggested a reinfection (ie, case 3-mesial aspect; case 5-mesial and distal aspects). Mean DR values ± standard deviation were 59.4% ± 47.59% (95% confidence interval [CI], 0.31%-118.49%). When infected aspects were excluded, resulting values were 85.76% ± 4.86% (95% CI, 78.02%-93.50%). The presented surgical procedure was associated with a clinically important DR in advanced peri-implantitis defects.

Changes of the peri-implant soft tissue thickness after grafting with a collagen matrix

Background: The aim of this study was to determine the treatment outcome of the use of a porcine monolayer collagen matrix (mCM) to increase soft-tissue volume as a part of implant site development. Materials and Methods: Implants were placed in single sites in 27 patients. In the test group, mCM was used for soft-tissue augmentation. No graft was placed in the control group. Soft-tissue thickness (STTh) was measured at the time of surgery (T0) and 6 months postoperatively (T1) at two sites (STTh 1, 1 mm below the gingival margin; STTh 2, 3 mm below the mucogingival margin). Results: Significant increases (P < 0.001) in STTh (STTh 1 = 1.06 mm, 117%; STTh 2 = 0.89 mm, 81%) were observed in the test group. Biopsy results showed angiogenesis and mature connective tissue covered by keratinized epithelium. Conclusions: Within the limitations of this study, it could be concluded that mCM leads to a significant increase of peri-implant soft-tissue thickness, with good histological integration and replacement by soft tissue and may serve as an alternative to connective tissue grafting.

Comprehensive Treatment of Severe Periodontal and Periimplant Bone Destruction Caused by Iatrogenic Factors

Dental implant success requires placement after periodontal therapy, with adequate bone volume, plaque control, primary stability, control of risk factors, and use of well-designed prostheses. This report describes the surgical and prosthetic management of a patient with severe iatrogenic periodontal/periimplant bone destruction. Methods. A 55-year-old female smoker with fixed partial dentures (FPDs) supported on teeth and implants presented with oral pain, swelling, bleeding, and a 10-year history of multiple implant placements and implants/prosthesis failures/replacements. Radiographs showed severe bone loss, subgingival caries, and periapical lesions. All implants and teeth were removed except implants #4 and #10 which served to retain an interim maxillary restoration. Bone defects were covered with nonresorbable dPTFE membranes. In the mandible, three new implants were placed and loaded immediately with a bar-retained temporary denture. Results. Seven months postoperatively, the bone defects were regenerated, and three additional mandibular implants were placed. All mandibular implants were splinted and loaded with a removable overdenture. Conclusions. In this case, periimplant infection and tissue destruction resulted from the lack of periodontal treatment/maintenance and failure to use evidence-based surgical and loading protocols. Combination therapy resolved the disease and the patients severe discomfort while providing immediate function and an aesthetic solution.

Lateral Wall Regeneration and Membrane Repair after Attempted Sinus Augmentation Using a Non-Resorbable Membrane

I nsufficient bone height for dental implant placement is often encountered in the posterior maxilla. Its main causes are postextraction alveolar ridge resorption and increased maxillary sinus size due to the prolonged absence of teeth. Different procedures to increase the bone volume available for implant placement have been described. Among them, sinus elevation using a lateral window is well documented and predictable. Despite the procedure’s generally high success rate, intraoperative complications may occur. A frequently encountered problem is tearing of the Schneiderian membrane, which can often be resolved, enabling successful treatment completion, with the placement of an internal resorbable membrane. When this is not possible, surgical closure and later re-attempting of the procedure may be advisable. Surgical flap closure without a membrane may result in insufficient bony repair of the lateral wall. The use of barrier membranes for guided bone regeneration may achieve bony repair of the defect. This report describes a case in which d-polytetrafluoroethylene (dPTFE) membrane use resulted in complete repair of the buccal wall and Schneiderian membrane.