Comparison of two full‐mouth approaches in the treatment of peri‐implant mucositis: a pilot study

Objectives: The aim of the present study was to test the hypothesis that an additional full‐mouth disinfection results in a greater clinical and microbiological improvement compared with sole mechanical debridement within one session in patients with peri‐implant mucositis and treated chronic periodontitis. Material and methods: The study included 13 partially edentulous patients (mean age 51.5 years) with treated chronic periodontitis and 36 dental implants with mucositis (bleeding on probing and/or a gingival index ≥1 at least at one site at baseline, absence of peri‐implant bone loss during the last 2 years before baseline). After randomized assignment to a test and a control group, patients received a one‐stage full‐mouth scaling with or without chlorhexidine. Clinical and microbiological examination was performed at baseline, after 1, 2, 4 and 8 months. Additional microbial samples were taken 24 h after treatment. Microbiological analysis was performed by real‐time polymerase chain reaction. Results: Both treatment modalities resulted in significant reductions of probing depth at implant sites after 8 months, with no significant group differences. The bacteria at implants and teeth could be reduced in every group 24 h after treatment; however, this reduction was not significant after 8 months. Conclusions: Both treatment modalities led to an improvement of the clinical parameters and a temporary reduction of the microflora at implants with mucositis, but without significant inter‐group differences after 8 months. To cite this article:
Thöne‐Mühling M, Swierkot K, Nonnenmacher C, Mutters R, Flores‐de‐Jacoby L, Mengel R. Comparison of two full‐mouth approaches in the treatment of peri‐implant mucositis: a pilot study.
Clin. Oral Impl. Res. 21 , 2010; 504–512.
doi: 10.1111/j.1600‐0501.2009.01861.x     

A randomized clinical trial on the short-term clinical and microbiological effects of the adjunctive use of a 0.05% chlorhexidine mouth rinse for patients in supportive periodontal care

OBJECTIVE: To evaluate the clinical and microbiological activity of a new mouth rinse formulation, used as an adjunct to oral hygiene, for patients in supportive periodontal care. PATIENTS AND METHODS: This was a randomized, placebo-controlled clinical trial with two groups: test group, rinsing twice per day with the test product (with 0.05% chlorhexidine and 0.05% cetylpyridinium chloride); and control group, rinsing with a placebo. Treated chronic periodontitis patients were included, and two visits were rendered, baseline, and after 15 days. Clinical outcome variables included plaque and gingival indices, and probing pocket depth. Subgingival samples were processed by culturing. Patient-based variables and adverse effects were also assessed. Outcome variables were compared by t-test, chi2, and Mann-Whitney test. RESULTS: The results belonged to 33 patients. Plaque and gingival indices, and the log of bacterial total counts were reduced in the test group (p < or = 0.01), but differences between groups were only statistically significant (p < 0.05) for plaque and bacterial counts. A significant reduction in the proportions of flora (p < 0.05) and frequency of detection (p = 0.01) of Porphyromonas gingivalis was observed in the test group. CONCLUSIONS: The newly formulated mouth rinse demonstrated short-term plaque-inhibitory activity. This was associated with a reduction in the total load of anaerobic subgingival microflora.     

Randomized clinical trial of the effects of azithromycin use in the treatment of peri‐implantitis

Background

The aim of this clinical trial was to establish a proof of concept that the adjunctive use of systemic azithromycin (AZM) in conjunction with mechanical debridement has an increased benefit in reducing soft tissue inflammation in the treatment of peri‐implantitis.

Methods

In a randomized, double‐blind, clinical trial, the treatment group (nine patients) received AZM as well as mechanical debridement in a single course of treatment, whereas the control group (eight patients) received a placebo and mechanical debridement. The primary outcome variables studied were bleeding on probing, suppuration, pocket probing depth and gingival recession. The secondary variables studied were gingival index, plaque index, microbiological and interleukin‐1β status. The observation period was 6 months.

Results

Over the 6 months’ observation period, the treatment patients showed a consistently greater reduction of gingival inflammation and an improvement in soft tissue healing than the control patients.

Conclusions

The adjunctive use of a single course of systemic azithromycin can assist in the control of peri‐implant mucositis in the treatment of peri‐implantitis.     

Clinical and microbiological efficacy of an antimicrobial mouth rinse containing 0.05% cetylpyridinium chloride in patients with gingivitis

To cite this article:
Int J Dent Hygiene 10 , 2012; 98–106
DOI: 10.1111/j.1601‐5037.2011.00523.x Rioboo M, García V, Serrano J, O’Connor A, Herrera D, Sanz M. Clinical and microbiological efficacy of an antimicrobial mouth rinse containing 0.05% cetylpyridinium chloride in patients with gingivitis. Abstract: Objectives: the aim of this study was to evaluate the effects of the use of a mouth rinse and dentifrice with cetylpyridinium chloride (CPC) in patients with gingivitis. Methods: the study was designed as a 1‐month, double‐blind, parallel, randomized clinical trial comparing a negative control regimen (minus active ingredients dentifrice and mouth rinse) with the test products (dentifrice and mouth rinse with 0.05% CPC) in terms of plaque and gingival indexes (PI, GI), patient‐based and microbiological outcome variables. The comparisons in relation to the main outcome variables (PI and GI) were made by means of the t‐test, either unpaired or paired for the intergroup and intragroup comparisons, respectively. Results: no differences were detected at baseline. Both groups showed statistically significant decreases in GI (0.17–0.19), without intergroup differences. The PI demonstrated a significant decrease of ?0.12 in the test group and minor changes in the negative control group (increase of +0.01). Differences between groups showed a tendency towards statistical significance. A limited impact was observed for microbiological variables in both groups. Conclusion: the results of this study show limited benefits of the evaluated formulations as adjuncts to unsupervised oral hygiene in reducing plaque accumulation, and no effect on gingivitis.     

A 0.05% cetyl pyridinium chloride/0.05% chlorhexidine mouth rinse during maintenance phase after initial periodontal therapy

BACKGROUND: Chlorhexidine (CHX) mouth rinse/spray can still be considered the gold standard in the chemical prevention of plaque formation and development of gingivitis. The product unfortunately has some side effects, such as extrinsic tooth staining, poor taste, taste disturbance, sensitivity changes in tongue, pain and irritation because of the alcohol content. These side effects led to the search of new formulations. METHODS: In this double-blind, randomized, long-term, parallel study, 48 moderate periodontitis patients rinsed for 6 months (starting immediately after a "one-stage, full-mouth" disinfection) with one of the following products: CHX 0.2%+alcohol (Corsodyl), CHX 0.05%+ cetyl pyridinium chloride (CPC) 0.05% and no alcohol (Perio-Aid Maintenance, a new formulation), or the placebo of the latter. After 1, 3 and 6 months a series of clinical and microbiological parameters were recorded for the supra- and subgingival area as well as for saliva. RESULTS: Although there was a significant treatment impact (mechanical debridement) in all groups, both CHX solutions further decreased both plaque and gingivitis indices (p<0.001 and p<0.05, respectively), when compared with placebo. This was also reflected by additional reductions in the number of CFU/ml of aerobic and especially anaerobic species and by a suppression of Streptococcus mutans (versus an overgrowth for the placebo), in all niches. Differences between both CHX solutions were never encountered. The subjective ratings were slightly in favour of the new CHX-CPC formulation when compared with the other CHX-alcohol formulation, especially for taste of the product (p<0.05), but less impressive for the staining of teeth and tongue. CONCLUSIONS: The results of this study demonstrated the potential of a new CHX 0.05%+CPC 0.05% non-alcoholic formulation as an effective antiplaque agent for long-term use with reduced subjective side effects.     

Diagnostic accuracy of clinical parameters to monitor peri‐implant conditions: A matched case‐control study

1 Background

The aim of this case‐control study was to estimate the diagnostic accuracy of the standard clinical parameters in diagnosing healthy peri‐implant tissues, peri‐implant mucositis, and peri‐implantitis.

2 Methods

A case‐control study was designed to compare the clinical parameters used in the diagnosis of peri‐implant diseases such as: probingdepth (PD), bleeding on probing (BOP), mucosal redness (MR), suppuration (SUP), and plaque index (PI). Furthermore, the influence of patient‐ (sex, age) and implant‐related variables (implant neck configuration, time in function after loading) were evaluated to investigate the association with the clinical findings. The inferential analysis consisted of estimation by generalized estimating equations (GEE) of multilevel logistic regression models.

3 Results

In total, 1,572 sites were evaluated around 262 implants from 141 patients. Sites with implant mucositis showed significant levels of BOP (OR = 3.56), MR (OR = 7.66) and PD (OR = 1.48) compared to healthy sites. The specificity was 90.3% while the sensitivity was only 43.6%. Likewise, sites exhibiting peri‐implantitis showed significant levels of BOP (OR = 2.32), MR (OR = 7.21), PD (OR = 2.43) and SUP (OR = 6.81) compared to healthy sites. Again, the multiple logistic regressions showed high specificity (92.1%) but modest sensitivity (52.5%). PD was the only diagnostic marker displaying significance comparing peri‐implant mucositis and peri‐implantitis sites (OR = 1.76). Moreover, tissue‐level compared to bone‐level implants were less associated with SUP+ (OR = 0.20), and PI (OR = 0.36) and demonstrated statistical significance. In addition, age, sex, and function time significantly influenced the tested clinical parameters.

4 Conclusions

The diagnosis of peri‐implant diseases cannot rely solely upon individual clinical parameters but rather require a combination of criteria. The clinical parameters, particularly probing depth, might accurately discern between diagnoses among peri‐implant conditions. Nevertheless, the specificity of the clinical parameters surpasses the sensitivity in the detection of peri‐implant diseases, validating its potential use as a diagnostic tool.