Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans

Aim: The aim of the present study was to evaluate the outcome of a surgical procedure based on pocket elimination and bone re‐contouring for the treatment of peri‐implantitis. Material and methods: The 31 subjects involved in this study presented clinical signs of peri‐implantitis at one or more dental implants (i.e. ≥6 mm pockets, bleeding on probing and/or suppuration and radiographic evidence of ≥2 mm bone loss). The patients were treated with a surgical procedure based on pocket elimination and bone re‐contouring and plaque control before and following the surgery. At the time of surgery, the amount of bone loss at implants was recorded. Results: Two years following treatment, 15 (48%) subjects had no signs of peri‐implant disease; 24 patients (77%) had no implants with a probing pocket depth of ≥6 mm associated with bleeding and/or suppuration following probing. A total of 36 implants (42%) out of the 86 with initial diagnosis of peri‐implantitis presented peri‐implant disease despite treatment. The proportion of implants that became healthy following treatment was higher for those with minor initial bone loss (2–4 mm bone loss as assessed during surgery) compared with the implants with a bone loss of ≥5 mm (74% vs. 40%). Among the 18 implants with bone loss of ≥7 mm, seven were extracted. Between the 6‐month and the 2‐year examination, healthy implants following treatment tended to remain stable, while deepening of pockets was observed for those implants with residual pockets. Conclusion: The results of this study indicated that a surgical procedure based on pocket elimination and bone re‐contouring and plaque control before and following surgery was an effective therapy for treatment of peri‐implantitis for the majority of subjects and implants. However, complete disease resolution at the site level seems to depend on the initial bone loss at implants. Implants with no signs of peri‐implantitis following treatment tended to remain healthy during the 2‐year period, while a tendency for disease progression was observed for the implants that still showed signs of peri‐implant disease following treatment. To cite this article:
Serino G, Turri A. Outcome of surgical treatment of peri‐implantitis: results from a 2‐year prospective clinical study in humans.
Clin. Oral Impl. Res. 22 , 2011; 1214–1220.
doi: 10.1111/j.1600‐0501.2010.02098.x     

Oral cancer adjacent to dental implants mimicking benign lesions: a case series study

Despite the long‐term survival rates of osseointegrated dental implants, several biological complications are known to affect the peri‐implant tissues, such as peri‐implant mucositis and peri‐implantitis. Occasionally, the clinical features of these more common benign lesions, or others nonrelated to implants, might be similar to oral malignancies, leading to misdiagnosis. The objective of this study was to present a case series of oral cancer located adjacent to dental implants, aimed to identify the reasons for initial misinterpretation of diagnosis. Thirteen patients, 10 females and 3 males, aged 59 to 90, were assessed. Among the differential diagnoses established, a malignant or premalignant lesion was not considered in 10 out of the 13 patients. Peri‐implantitis was the most common preliminary diagnosis, followed by fungal infection, viral infections, and traumatic ulcers. The meantime for the diagnosis of oral cancer was 21.5 months. The clinical presentation of peri‐implant malignancy, such as ulceration, white and red plaques, and exophytic lesions, might mimic benign diseases that are more common in the oral cavity. Suspicious lesions with treatment failure that persist for more than 2 weeks require biopsy and histopathological analysis to establish an early definitive diagnosis to improve the prognosis and quality of life of the patients.     

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 evaluation of an implant maintenance protocol for the prevention of peri-implant diseases in patients treated with immediately loaded full-arch rehabilitations

To cite this article:
Int J Dent Hygiene 9 , 2011; 216–222
DOI: 10.1111/j.1601‐5037.2010.00489.x
Corbella S, Del Fabbro M, Taschieri S, De Siena F, Francetti L. Clinical evaluation of an implant maintenance protocol for the prevention of peri‐implant diseases in patients treated with immediately loaded full‐arch rehabilitations. Abstract: Objective: The aim of this prospective study was to assess the outcomes of an implant maintenance protocol for implants supporting a full‐arch rehabilitation. Materials and methods: Sixty‐one patients (28 women and 33 men) treated with immediately loaded full‐arch rehabilitation, both mandibular and maxillary, supported by a combination of two tilted and two axial implants, were included in the study. Patients were scheduled for follow‐up visits every 6 months for +2 years, then yearly up to 4 years. Each patient received professional oral hygiene treatment and detailed oral hygiene instructions. During each visit, modified plaque index, bleeding index and probing depth were assessed. The presence of peri‐implant tissue inflammation was also evaluated. Results: Mean observation time, considering both mandible and maxilla, was 18.3 months ranging from 6 months to 5 years. Both plaque and bleeding indexes frequency decreased over time. Probing depth was stable (2.46 ± 0.5 mm at 4 years). Only three implants were lost due to peri‐implantitis (1.4% at 12 months), whereas the incidence of peri‐implant mucositis was less than 10% in each considered period. Conclusions: The adoption of a systematic hygienic protocol is effective in keeping low the incidence of peri‐implant mucositis as well as in controlling plaque accumulation and clinical attachment loss.