ABSTRACT
BACKGROUND: Peri-implantitis poses a significant challenge in dental implantology due to its potential to result in the loss of supporting tissue around dental implants. Surgical reconstruction is often recommended for intrabony defects, accompanied by various adjunctive therapies, such as antimicrobial photodynamic therapy (aPDT), for bacterial decontamination. However, the long-term efficacy of such treatments remains unclear. METHODS: This clinical report presents a case of peri-implantitis management in a healthy 55-year-old male using guided bone regeneration principles and surface decontamination via aPDT. The patient exhibited peri-implantitis with probing pocket depths (PPD) of 7 mm at buccal sites, 5 mm at palatal sites, and significant bone loss around implant #12. The reconstructive approach involved preservation of the existing implant and following a non-submerged healing protocol. The surgical phase included meticulous debridement, chemical detoxification with hydrogen peroxide, and aPDT using a 670 nm diode laser with methylene blue as the photosensitizer. Xenogenic bone graft and a resorbable collagen membrane were applied and the patient was followed up to through a 5-year period. RESULTS: Postsurgery the patient exhibited normal healing, and long-term follow-up at 5 years showed reduced PPD (2 mm buccally, 3 mm mid-palatally), complete intrabony defect fill, and stable bone levels, indicating successful treatment. CONCLUSIONS: This case report demonstrates the potential long-term success of a reconstructive approach with adjunctive aPDT in peri-implantitis management. However, it highlights the need for standardized protocols and further clinical trials to establish the clinical benefits of aPDT in surgical reconstruction of peri-implantitis defects, serving as valuable pilot data for future research. HIGHLIGHTS: Why is this case new information? Provides a rare 5-year insight into peri-implantitis intrabony defect reconstruction, offering extended success and outcomes not frequently documented. Demonstrates the efficacy of aPDT with a 670-nm diode laser in achieving successful long-term outcomes, contributing valuable evidence to existing literature.Keys to successful management of this case: Success involves initial non-surgical debridement followed by a reconstructive strategy, incorporating guided bone regeneration and surface decontamination via aPDT. Long-term success hinges on patient compliance with routine oral hygiene, emphasizing the importance of adherence to preventive measures post-reconstruction to minimize recurrence risk.What are the primary limitations to success in this case? Variability in photosensitizer uptake, and potential risks such as tissue damage and bacterial resistance pose challenges to the effectiveness of aPDT. The existing literature on aPDT in peri-implantitis treatment lacks standardization in methodology, laser parameters, and follow-up durations, making it challenging to establish a universally accepted protocol.
ABSTRACT
Introduction - Scaffolds and cells are two important components in bone tissue engineering. There is a gap of information about stem cell activity next to bone substitutes. Thus, the aim of this in vitro study was to compare the proliferation and differentiation of bone marrow stem cells (BMSCs) and dental pulp stem cells (DPSCs) in presence of freeze-dried bone allograft (FDBA). Method and Materials - DPSCs and BMSCs were cultured and placed on mineralized bone allograft. Cell proliferation was analyzed by the methyl thiazolyl tetrazolium (MTT) assay after 24, 48, and 72 h. To compare the enzymatic activity and mineralization of cells, the alkaline phosphate (ALP) test and alizarin red staining were performed at 30 days. Data were analyzed by ANOVA. Results - The rate of proliferation of DPSCs was higher at 48 and 72 h. ALP activity was significantly higher in DPSCSs (P < 0.05), while alizarin red staining did not show any significant difference between the groups in formation of calcified nodules. DPSCs showed higher cell proliferation and osteoblastic differentiation than BMSCs. Conclusion - Considering the easier and less invasive isolation of DPSCs, a combination of DPSCs and allograft can be a good choice for bone regeneration, especially in the dentoalveolar area.
